JCRC Student to Student Application
To participate in the 2023-2024 school year, please fill out this form and return it to the JCRC as soon as possible.
Learn more about the program here: https://www.jcrcboston.org/student-to-student-program/
Your Information
First Name
Last Name
Email
Street Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
Palau
Zip Code
Cell Phone
Home Phone
Name of Your High School
In 2023-2024, I will be a:
Junior
Senior
Jewish Education (please describe):
I have visited Israel
on an organized program
on a private trip
not yet
If you visited Israel on an organized program, which program was it?
Synagogue Affiliation
If you are a member of a youth group, which one do you belong to?
I will have a car available next year:
Yes
No
Maybe
Are you self-nominating?
Yes
No
Reference Information
Reference First Name
Reference Last Name
Reference Address
Reference cell phone
Reference email address
Parent 1 Information
Parent 1 First Name
Parent 1 Last Name
Parent 1 Address
Parent 1 cell phone
Parent 1 email address
Parent 2 Information
Parent 2 First Name
Parent 2 Last Name
Parent 2 Address
Parent 2 cell phone
Parent 2 email address
Short essay paragraph: Please explain why you are interested in the Student to Student program.
Contact Information