Class Adopt-A-Survivor of Jewish Federation of Greater MetroWest
Please complete the form below for your class to learn about a Holocaust survivor’s life and create a project that tells the survivor’s story. Please contact Patricia Dipette at pdipette@jfedgmw.org if you have questions.
Your Information
Name
*
First Name
Last Name
Email
Confirmation Email
example@example.com
School Information
Name
*
Which grade(s) are the students in?
*
Phone Number
*
Email
*
Confirmation Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
When does your class meet? (please be specific in timing on days of the week, etc.)
*
At what time would you like a survivor to speak to your class?
*
How many students are in the class?
*
Please provide us with a brief description of the course.
*
Please provide us with a brief understanding of how much Holocaust knowledge the students have.
*
The Holocaust Council appreciates your honorarium of $180 if virtual and $360 if in person. Please select one of the payment methods below. An invoice will be provided
*
Check
Credit Card (fees apply)
PaymentData
Payment Information
*
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Honorarium
$
360.00
In-person
Virtual
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
SUBMIT
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