ACT: Agents of Change Training Application
Applications are due by June 26, 2026
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Employer and Title, if applicable
If accepted, I agree to the $360 participation fee. I also understand that participation requires that I attend at least 7 of the 8 sessions and that the orientation session is mandatory.
Yes
What aspects of the program interest you? Please check all that apply.
Greater self-reflection and awareness
Relationship building with like minded women
Tools for growth
Networking/ exposure to community leaders
Skill development
Why are you interested in joining ACT and what do you hope to gain from the program?
If selected to participate, what unique perspective would you bring to the ACT table?
Do you consider yourself more of a talker or listener (or both)? Please explain
How did you hear about ACT?
Please provide a brief bio. Please include any past or present involvement in the Jewish community.
Submit
Should be Empty: