Chabad Brandeis 360° Student Form

Chabad Brandeis 360°

Student Form
We're excited about your interest in Chabad Brandeis 360°! This form helps us get to know you and understand how this experience can fit into your college journey. After you submit this form we will reach out to schedule a personal Zoom conversation.
Student Information
Name*

First NameLast Name
Email (non-Brandeis)*
example@gmail.com
Phone Number*
Class Year*
Major/Intended Major*
Your Journey & Interest
How did you hear about Chabad Brandeis 360°?*
Tell us about your Jewish background and any previous experiences with Jewish learning or community involvement:*
What draws you to Chabad Brandeis 360°?*
What are you hoping to gain from participating in Chabad Brandeis 360°? *
How would you describe your current relationship with personal reflection?*
What topics or areas of personal growth are you most interested in exploring?*

Jewish identity and practiceLife purpose and valuesRelationships and communicationPost-college planningLeadership skillsOther
Please share
How would you describe your previous participation in Chabad at Brandeis programs?*
Commitment & Participation
Which program option are you considering?*
Weekly Shabbat Dinners - How do you envision participating?*
Please elaborate *
Learning Sessions - How interested are you?*
Please elaborate*
One-on-One Mentoring - How do you feel about this component?*
Please elaborate*
What commitments or activities might impact your participation? We understand this is fluid, but it may be helpful to know in advance.
Parent Information
What is your parents' perspective on your participation in Chabad Brandeis 360°? *
Parent/Guardian 1*

First NameLast Name
Relationship*
Phone Number*
Email*
Parent/Guardian 2

First NameLast Name
Relationship
Phone Number
Email
Family Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you parents like to join your intake conversation*
Would your family be interested in the optional Parent Learning sessions about the Soular System™?*
Partnership & Scholarship
Which are you and your family considering?*
What amount is your family comfortable with?
When do you prefer to do make your contribution?
Please elaborate
How do you prefer to make your contribution?
Please elaborate
If you're interested in scholarships, would you prefer to discuss this:
Anything Else?
Is there anything else you'd like us to know about you, your interests, or your goals?
Do you have any questions about Chabad Brandeis 360° that can be addressed during your conversation with Chanie and Peretz?
What days work best for your Zoom conversation with Chanie or Peretz?*

SundayMondayTuesdayWednesdayThursdayFriday
What times work for you on your selected days*
After submitting this form, you’ll be redirected to a Calendly link to schedule a conversation with Chanie and Peretz.
Should be Empty:

Chabad Brandeis 360°

Student Information

Your Journey & Interest

Commitment & Participation

Parent Information

Partnership & Scholarship

Anything Else?