First Name

Last Name

Preferred Name / Nickname

Gender

Mobile Phone

Home Phone

Street Address

Address 2 (if applicable)

City

State

Zip

What school do you attend?

What grade will you be in the fall?

9th

10th

11th

12th

Are you involved with a local youth group? If so, which one?

NFTY

USY

NCSY

BBYO

Other

What Synagogue do you belong to? (if applicable)

Parent 1

Parent 1 First Name

Last Name

Mobile Phone

Home Phone

Parent 2

First Name

Last Name

Street Address (if different)

Address 2 (if applicable)

City

State

Zip

Mobile Phone

Home Phone

Do you participate in any organizations or clubs? (Please list any school clubs, summer camps, charities, JCC’s, youth groups, etc. and the dates that you have been involved with these activities):

Describe an experience you have had giving tzedakah, fundraising for a cause, doing community service, or volunteering. What did you take away from that experience?

How would you describe your Jewish identity? How does it impact who you are and what your life is like? ** (Please keep in mind, there is no correct answer. We enjoy working with teens who express their Judaism in all different kinds of ways and those who are exploring it for the first time)

Are you shomer Shabbat?

Yes

Do you require Kosher meals?

Yes

Why are you interested in participating in No Small Change? What skills and attributes would you bring to the group? What skills would you hope to develop?

No Small Change is an educational program as well as a giving circle. JWF provides matching funds for NSC grantmaking, but each participant is required to raise at least $250 through fundraising and/or personal contribution for grants. If accepted into the 2021 No Small Change cohort, do you agree to raise $250 to contribute to the giving circle?

Yes

I have checked with my family and I am able to attend the Orientation Retreat, all 8 regular meetings, and the Grant Announcement Celebration.

Yes

If you have any schedule conflicts, please explain here:

Please download, sign, and attach the completed Participation Agreement, with parent signatures.

Upload the completed Participation Agreement here

How did you hear about No Small Change?

I understand that if I am accepted as a participant, I will be required to pay a $125 participation fee to JWF. (If this creates a financial hardship for you, please select “No” and send an email to jennifer@jwfpalmbeach.org to discuss alternative arrangements.)

Yes

registration application

Let’s Get Started

Address:

Phone:

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