Stipend Collection
**Important Note: If you have participated in multiple cohorts, you must fill this form out for EACH cohort in order to receive your stipends. Thank you!
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cohort
*
York & Ryerson - ILF
York - JLF
UofT - ILF
UofT - JLF
Ryerson - JLF
Waterloo/Laurier - JLF
Western - Hatikvah Fellowship
Western - JLF
Queen's - JLF
Queen's - Navigate
Text 2 Life
Hatikvah Fellowship: Face2Face
Your stipend is $250. Please indicate how much you would like to give back for another student to have this meaningful experience. This amount will be deducted from the e-transfer you will receive.
*
$54
$36
$18
I'm not interested in giving back at this time.
Other
Your stipend is $300. Please indicate how much you would like to give back for another student to have this meaningful experience. This amount will be deducted from the e-transfer you will receive.
*
$54
$36
$18
I'm not interested in giving back at this time.
Other
Your stipend is $120. Please indicate how much you would like to give back for another student to have this meaningful experience. This amount will be deducted from the e-transfer you will receive.
*
$54
$36
$18
I'm not interested in giving back at this time.
Other
Your stipend is $150. Please indicate how much you would like to give back for another student to have this meaningful experience. This amount will be deducted from the e-transfer you will receive.
*
$54
$36
$18
I'm not interested in giving back at this time.
Other
Your stipend is $50 per session. Please indicate how much you would like to give back for another student to have this meaningful experience. This amount will be deducted from the e-transfer you will receive.
*
$54
$36
$18
I'm not interested in giving back at this time.
Other
Thank you so much for your participation!
Submit
Should be Empty: