JF&CS Israel Support Intake Form

Israel Support Intake Form

JF&CS stands with Israel and we are here to support you or your organization. Should you or anyone you know need help during this time of crisis, please complete the following intake form below. Submissions are reviewed Monday - Friday and return calls are made 9a-5p. If you need more urgent assistance, please reach out by phone to 770.677.9399.
Your name*

First NameLast Name
Your email*
example@example.com
Your phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Are you filling this form out for yourself, someone else, or on behalf of an organization?*
Have you or the primary applicant been directly affected by the war in Israel?

YesNo
Please note: these services are intended for Israelis and members of the Atlanta Jewish community directly affected by the war in Israel. If you do not identify with either of these communities, please click here to learn more about our other services.
Name of your organization
Phone number for your organization
Please enter a valid phone number.Format: (000) 000-0000.
Primary Applicant Name*

First NameLast Name
Primary Applicant Age*
Preferred method of contact

PhoneEmailWhatsApp
WhatsApp Number
What is your relationship to the primary applicant?*
If Other, please specify:*
Do you/they require language assistance?*
Do you/they have dependents?
Name of Dependent #1

First NameLast Name
Age of Dependent #1
Relationship to primary applicant
Would you like to add another dependent?
Name of Dependent #2

First NameLast Name
Age of Dependent #2
Relationship to primary applicant
Would you like to add another dependent?
Name of Dependent #3

First NameLast Name
Age of Dependent #3
Relationship to primary applicant
Would you like to add another dependent?
Name of Dependent #4

First NameLast Name
Age of Dependent #4
Relationship to primary applicant
Do you/they have access to transportation?
Are you or the primary applicants currently receiving assistance from any other community resources? If yes, please specify below:
JF&CS Offers the following services:
I am interested in the following services (please check all that apply):*

Emotional Support ServicesOne Good Deed (Older Adult Friendly Visitor Program)PAL (Jewish Big Brother/Sister Mentoring Program)
Please share in what capacity you are seeking to partner/access resources from JF&CS?
Should be Empty: