Student to Student Nomination

Please complete the form below to nominate a student for the 2024-25 Student to Student program.

THANK YOU FOR NOMINATING STUDENTS WHO WILL BE IN 11TH OR 12TH GRADE IN THE 2024-25 SCHOOL YEAR.

Please share as much contact information as you have for both student and parents. Submit a new form for each teen being recommended.

Please direct any questions to Aaron Gorodzinsky, Director of Development at [email protected] to (610) 821-5500, ext. 337.

NOMINATOR INFORMATION

Name

Address

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Optional Donation:

RECOMMENDED STUDENT DETAILS

Name of Nominee

Date of Birth

Email of Nominee

Phone Number of Nominee

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Synagogue Affiliation of Nominee

Jewish Youth Group Affiliation of Nominee

High School of Nominee

Grade of Nominee in 2024-25

Parent Name of Nominee

Parent Email

Parent Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Please include any other relevant information about the nominee. Some suggestions: In what capacity do you know the nominee, what qualities does the nominee have that would make them a good match for our program?

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