21-Day Plant Powered Jumpstart Registration
Jewish Veg and Plant Powered Metro New York (PPMNY) are excited to welcome you into our 21-Day Plant Powered Jumpstart! This whole food, plant-based (WFPB) nutrition jumpstart is designed to introduce you to evidence-based principles of healthy eating and provide you with support to make substantial dietary change for health and healing. Please complete this registration form no later than Sunday, April 30, 2023. Note that by registering for this program you are communicating your readiness to adopting the dietary guidelines of a whole food, plant-based diet for 21 days. Please direct any questions to firstname.lastname@example.org.
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Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Preferred phone number
Date of birth
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How did you hear about the Jumpstart?
From Jewish Veg
From my synagogue
From another Jewish communal organization
From a friend or family member
If you are participating with someone else -- like a family member, friend, or colleague -- share their name(s) here. (Note that each adult requires separate registration, but we'd like to know who is signing up together.)
If you are participating with others who are part of the same Jewish communal organization, please share the name of the organization here:
Motivation & Ability
Why are you interested in adopting a healthy plant-based diet? What motivates you to participate?
What questions do you have about health and nutrition that you would like to explore in this program?
These are the dates of our live virtual sessions which will be held on Zoom. Please let us know which sessions you will be able to attend live. Note that attendance is strongly encouraged for ALL sessions, though recordings will be available.
Orientation: Wednesday, May 3, 7:30 - 9:30 PM ET
Prep session: Sunday, May 7, 3:00 - 6:00 PM ET
Day 1: Wednesday, May 10, 8:00 - 9:00 PM ET
Day 8: Wednesday, May 17, 8:00 - 9:00 PM
Day 11: Sunday, May 21, 3:00 - 4:30 PM ET / 5:00 - 6:15 PM ET (Jumpstart session followed by a publicly available cooking demo)
Day 15: Wednesday, May 24, 8:00 - 9:00 PM ET
Day 22 closing celebration: Wednesday, May 31, 7:30 - 9:30 PM ET
Mentorship & Support
All jumpstart participants will be placed into small groups of 5-10 people supported by 1-2 peer Lifestyle Mentor(s) from the PPMNY and Jewish Veg communities. Mentors offer more personalized guidance, help you troubleshoot challenges, facilitate group discussion and learning, and point you toward more resources and meal ideas that will work for your lifestyle. Mentorship groups will meet weekly throughout the program.
By dragging the items below, please rank your top 1-3 mentorship track themes from the list. Anything ranked 4 or lower will not be considered. We will confirm your mentorship track by Wednesday, May 3.
You will be assigned to a mentorship group meeting at only one of the following times. Select all times that you are available to attend mentorship sessions from May 10 - 24 (three weeks). Note that evening times are adjacent to our full-group educational sessions taking place from 8-9 PM ET.
Wednesdays from 1:00 - 2:00 PM ET
Wednesdays from 7:00 - 8:00 PM ET
Wednesdays from 9:00 - 10:00 PM ET
Please let us know if you would like to participate in one of these platforms for group support during and after the program. All platforms can be used through a mobile app or computer. Check all that apply.
I am interested in joining a private Facebook group for past and current jumpstart participants.
I am interested in joining a WhatsApp group chat with my mentorship track.
We will be providing all Jumpstart materials at your fingertips through a special program app and other app-based resources. Please choose the statement that best reflects you.
I am comfortable using apps on my phone.
I will need some support accessing and using apps, but I'm open to learning.
I don't use apps and now isn't the right time for me to learn.
I don't have a smartphone.
About Me & Food
How comfortable are you with preparing your own meals?
Tell us about you and your kitchen. Check any that apply. (Note that any tools mentioned below are not required or necessary to participate in the program.)
I have time to spend in the kitchen.
I like to work from recipes.
I like to work with precut/frozen/canned ingredients.
I feel comfortable working with knives.
I have good kitchen tools.
I have a high-speed blender.
I have a slow cooker.
I have a pressure cooker.
Approximately how many times each week do you prepare your own meals for lunch and dinner?
6-7 days of the week
3-5 days of the week
1-2 days of the week
Never - someone else prepares my meals
Never - I always (or almost always) eat out or take in
Select whichever options below best describe what you currently eat. Check any that apply.
Omnivore (regularly eat meat)
Semi-vegetarian (only occasionally eat meat)
Pescatarian (fish, dairy, and eggs, but no meat)
Lacto-ovo vegetarian (dairy and eggs, but no meat or fish)
Vegan (no animal products)
Whole food, plant-based (little-to-no animal or processed foods)
The information in this section is being collected to ensure participant safety and will only be used by PPMNY's jumpstart leaders and our medical advisors. We request your honest disclosure. By answering these questions you affirm that they are true; please do not withhold information. **If you are on medication for diabetes or hypertension (high blood pressure), we require a brief intake call with one of our medical partners; you will be prompted through this registration form to sign up for a time to speak with them. In addition, it is essential that you work with your personal physician to monitor your medications over the course of the program, as you may need to reduce your dosages if you follow the dietary guidelines closely.
Have you been diagnosed with diabetes and/or hypertension? Check any that apply. Note that you are welcome to meet with a medical partner even if you have not been diagnosed with the below conditions.
Hypertension (high blood pressure)
I have not been diagnosed with any of the above but would like to speak with a medical partner.
I don't have these conditions or any medical concerns.
Are you on any medications for the above condition(s)? Check any that apply.
I am on a blood pressure lowering medication.
I take insulin.
I use another non-insulin diabetes medication.
Do you have a primary care physician, or do you see a specialist who supports your medical care and/or medications/dosing?
Please select a time to speak with one of our medical partners about monitoring your medication with your personal physician.
Final Thoughts & Waivers
Do you have any other questions or concerns about the Jumpstart program?
To complete the enrollment process, you must read and agree to BOTH of the following forms.
By signing, you agree to the content outlined in the two waivers above:
Consenting to the following waiver is not mandatory for participation in the program.
Select whether you consent or do not consent to the above publicity release waiver:
I do not consent.
Jumpstart participation rates are heavily discounted thanks to the generosity of the Ancowitz and Kanner families in memory of Arthur Ancowitz, MD, a pioneer in disease prevention through diet and lifestyle. Full-price participation is typically $150 per person, but general access to this jumpstart is only $36 and there is a student rate of $18. To thank our Jewish communal professionals and clergy, access to the jumpstart is offered for free. Please request a scholarship code by emailing email@example.com; then, input your scholarship code below.
Select the option that applies to you:
I am paying for my own participation.
I am participating with a group or organization that has sponsored my participation (requires provided sponsorship code).
As a Jewish communal professional or member of the clergy, I have received a scholarship to participate (requires provided scholarship code).
Choose your payment level:
General rate - pays for your participation: $36
Student rate - pays for your participation: $18
Which group or organization has sponsored you?
Which Jewish communal organization are you an employee of?
What is the name of your educational institution?
Sponsorship coupon code:
Scholarship coupon code
I would like to add a donation to my payment in the amount of:
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Pay with Credit Card
Debit or Credit Card
Credit Card Number
Please click one of the PayPal options to complete payment and
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