Class Adopt-a-Survivor Submission

Your Information
Name

First NameLast Name
Email

Confirmation Emailexample@example.com
School Information
Name
Which grade(s) are the students in?
Phone Number
Format: (000) 000-0000.
Email

Confirmation Emailexample@example.com
Address

Street Address

Street Address Line 2

CityState / 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.
Are you a Title 1 school?
Please select from the formats below
The Holocaust Council appreciates your honorarium of $180 if virtual and $360 if in person. Please select from the formats below
Please select one of the payment methods below. An invoice will be provided
Please send a check for ${theHolocaust} payable to Jewish Federation of Greater MetroWest to:

Jewish Federation of Greater MetroWest NJ
Attn: Trish DiPette
901 Route 10, P.O. Box 929
Whippany, NJ 07981-0921
PaymentData
charge amount
cc fee

USDDescription

Your Information