New Shluchim Registration

New Shluchim Registration

For help or any questions please contact help@chabadoncampus.org.
Please note this application will be sent to your head Shliach for approval.
Personal Information
We are*

New Shluchim just moving outExisting Shluchim just joining the COCI Network
Shliach Name*

First NameLast Name
Shliach Email*
example@example.com
Shliach Cell Number*

Area CodePhone Number
Shlucha Name*

First NameLast Name
Shlucha Email*
example@example.com
Shlucha Cell Number*

Area CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Moved on Shlichus*

MonthDayYear
Date
Which one of these definitions best describes your Shlichus?*

Shluchim & Shluchos for whom the vast majority of their Shlichus is a university or college campus. Shluchim/os who fit this category live close to campus, offer weekly Friday night meals during the semester for students, teach classes regularly to students, etc.Shluchim & Shluchos who have a campus that they serve as a large component of their Shlichus, but still have other primary Shlichus responsibilities to a community. Shluchim/os who fit this category may have students on Friday night together with community members or have student-only Friday night meals monthly, etc.Shluchim & Shluchos who have a campus in their Shlichus territory and serve it infrequently. Shluchim/os who fit this category may visit the campus a few times a year, have infrequent events for students, etc.
What percentage of your Shlichus would you consider catered to college students?*

100%80-99%60-79%40-59%Less than 40%Other
Regional Head Shliach name*

First NameLast Name
Regional Head Shliach Email*
Local Head Shliach will be sent a copy of this application
Regional Head Shliach Cell Number*

Area CodePhone Number
State Head Shliach Name*

First NameLast Name
State Head Shliach Email*
State Head Shliach will be sent a copy of this application
State Head Shliach Cell

Area CodePhone Number
Chabad House Information
Official Mosad/Chabad House Name (No abbreviations).*
Is this an existing Mosad or a new Mosad?*

ExistingNewOther
Chabad House Website*
Are you an officially recognized Shliach under Merkos L'Inyonei Chinuch*

YesNo
Please put the link to your chabad.org directory page*
Please explain why you are not registered under Merkos L'Inyonei Chinuch*
Please upload a copy of your State Head Shliach’s authorization form that was submitted to Merkos

Browse Files

Cancelof
My Chabad House Address is

The same as my home addressDifferent than my home address
Chabad House Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Chabad House Phone Number*

Area CodePhone Number
Are there additional Shluchim on Campus?*

YesNo
How many additional Shluchim?*
How far, geographically, is your Chabad House from the primary campus you serve?*

0.2 mile0.5 mile2.0 miles3.0 miles5+ milesOther
School/s Information
How many schools do you service?*
School #1 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #1*

Full TimePart Time
School #2 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #2*

Full TimePart Time
School #3 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #3*

Full TimePart Time
School #4 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #4*

Full TimePart Time
School #5 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #5*

Full TimePart Time
School #6 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #6*

Full TimePart Time
School #7 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #7*

Full TimePart Time
School #8 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #8*

Full TimePart Time
School #9 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #9*

Full TimePart Time
School #10 Official School Name. (No abbreviations).*
Student population on campus*
Jewish Student population on campus*
School type/prestige*
Is there an active Greek life on campus?*

YesNo
The Chabad house services School #10*

Full TimePart Time
Responsibilities

Shliach
Shliach area of focus:*

Full Time CampusPart Time Campus / Part Time CYPPart Time Campus / Part Time CommunityOther
Shliach's student demographic responsibility:*

Undergraduate OnlyGraduate OnlyUndergraduate & GraduateOther
Shliach's primary role:*

Teaching & StudyingProgrammingAdministrationFundraisingAll the aboveOther
Responsibilities

Shlucha
Shlucha area of focus:*

Full Time CampusPart Time Campus / Part Time CYPPart Time Campus / Part Time CommunityOther
Shlucha's student demographic responsibility:*

Undergraduate OnlyGraduate OnlyUndergraduate & GraduateOther
Shlucha's primary role:*

Teaching & StudyingProgrammingAdministrationFundraisingAll the aboveOther
Student Outreach
How often do you host Friday night dinner primarily for college students?*

Every week during the semesterEvery week the whole yearEvery other weekMonthlyQuarterlyOther
Do you run holiday events specifically for college students*

High holidaysSukkosChanukahPurimPesachShavuosOther
How often do you give classes specifically for college students?*

2+ per weekWeeklyEvery other week (twice per month)MonthlyOther
How many students does the Shliach learn with one-on-one per week?*
How many students does the Shlucha learn with one-on-one per week?*
Do you have a student board?*

YesNo
When was your student board founded?

MonthDayYear
Date
How often does the board meet?

WeeklyEvery other week (twice per month)MonthlyEvery six months (twice per year)Other
Do you have a kosher meal plan?*

YesNo
How many students participate in your kosher meal plan?*
How often do you table on campus?*

WeeklyMonthlyOther
How many students have you sent to Yeshiva for a semester or longer?*
Do you run a Hebrew school?*

YesNo
How often do you plan to host Friday night dinner primarily for college students?*

Every week during the semesterEvery week the whole yearEvery other weekMonthlyQuarterlyOther
Do you plan to run holiday events specifically for college students?*

High holidaysSukkosChanukahPurimPesachShavuosOther
How often do you plan to give classes specifically for college students?*

2+ per weekWeeklyEvery other week (twice per month)MonthlyOther
How many students does the Shliach plan to learn with one-on-one per week?*
How many students does the Shlucha plan to learn with one-on-one per week?*
Do you plan to have a student board?*

YesNo
Do you plan to have a kosher meal plan?*

YesNo
How often do you plan to table on campus?*

WeeklyMonthlyOther
Do you plan to run a Hebrew school?*

YesNo
Do you have offerings primarily for graduate students?*

YesNo
Who is responsible for graduate students?*

Shliach onlyShlucha onlyShliach & Shlucha
What percentage of their time do they dedicate for graduate students?*

100%80-99%60-79%40-59%Less than 40%Other
Anything else we should know about your Shlichus as it relates to campus?
COC Alcohol Policy
We, the directors of Chabad at the above-listed school(s), hereafter referred to as “Chabad House,” acknowledge that the service of alcohol to individuals under the legal drinking age is unlawful in many jurisdictions and may pose significant health and safety risks. Accordingly, we adopt the following policy, effective immediately:
1. The sale, service, and consumption of alcoholic beverages on or in connection with college campuses are governed by applicable law and university regulations.
2. The leadership, staff, and volunteers of Chabad House are required to comply fully with all such applicable laws and regulations in the jurisdiction in which they operate.
3. No individual under the legal drinking age in the applicable jurisdiction may serve or consume alcohol at any Chabad House property or at any Chabad House–sponsored event.
4. No individual may serve, furnish, or otherwise provide alcohol to any person under the legal drinking age at any Chabad House property or Chabad House–sponsored event.
5. A limited exception may be made solely for ceremonial wine used for bona fide religious ritual purposes (e.g., Kiddush), and only in strict compliance with applicable law.
6. If this policy is reviewed in consultation with the relevant campus or institutional legal office, and written recommendations are provided, Chabad House may submit a revised version of this policy reflecting such recommendations. Any revised policy must be provided to Chabad on Campus International (COCI) for review and to be held on file.
We understand that any breach of this policy will be subject to review by the Vaad of Chabad on Campus International. A breach may result in disciplinary action, including suspension or termination of all COCI benefits and eligibility for any funding administered by COCI.

In addition, we agree to defend, indemnify, and hold harmless Chabad on Campus International from and against any claims, liabilities, damages, or expenses arising out of or related to a breach of this policy, and we acknowledge personal responsibility for such obligations.
Signature of Shliach*
Signature of Shlucha*
Comments
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New Shluchim Registration

Personal Information

Chabad House Information

School/s Information

Responsibilities

Responsibilities

Student Outreach

COC Alcohol Policy