Create and Connect: Synagogue Acceptance Form

Name of Synagogue*

Synagogue Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Synagogue Contact/ National Cohort Participant Information

BY SUBMITTING THIS APPLICATION I ACKNOWLEDGE THAT I WILL OVERSEE THE PROGRAM PLANNING AND IMPLEMENTATION

Your Name*

Your Email*

Your Phone*

Note: This number will be added to the National Cohort Whatsapp group.

Would you like to add a second Synagogue representative to the cohort?

Yes
No

Contact Name

First Last

Contact Email

Contact Phone

Note: this number will be added to the National Cohort WhatsApp group.

Cohort Commitment

Name of Cohort you have been selected to join:*

I will join the Cohort Launch Meeting (in the event of a conflict, I will appoint a volunteer who is involved in organizing the program to attend in my place.)

I will submit all necessary materials to the OU Women's Initiative.

THIS APPLICATION HAS BEEN APPROVED BY THE SYNAGOGUE RABBI AND ANY APPLICABLE LAY LEADERS