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Registration
JTLI Registration Form 2021-2022
Student Name
*
First
Last
Student Email
*
Student Phone Number
*
Parent/Guardian Name
*
First
Last
Parent/Guardian Email
*
Parent/Guardian Phone Number
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Grade entering in Fall 2021
*
9
10
11
12
Name of Synagogue you belong to
*
Cohort you're registering for
*
Year 1, 2021-22
Year 2, 2021-22
Why are you interested in JTLI?
*
Have you already participated in year 1?
*
Yes
No
Do you have a project or mentorship in mind?
If not, it's perfectly fine! If you do, please describe it here.
By clicking "I agree" below, the student commits to attending no less than 75% of the JTLI sessions during the 2021-22 academic year
*
I Agree
CAPTCHA
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