Mitzvah Project Central Student Registration UNAFFILIATED

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**This registration form is for individuals who are not affiliated with a participating congregation**

If you are affiliated with a participating congregation, please access the form that has been sent to you through your congregation or contact your B'nai Mitzvah coordinator.

IF NOT, CONTINUE BELOW

Dear B'nai Mitzvah Student,

You are becoming a B'nai Mitzvah this year (woohoo!), and Tzedek America would be thrilled to be part of the experience with you and your family. To register, please fill out the following form to help us get to know you a little bit and help you begin to think about how you want to engage in the mitzvah project component of your journey.

Here are some next steps!

1. Fill out the below form with your parent or guardian. It is absolutely okay if you don’t have an answer to any of the questions - that is what we’re here to help with!

2. Schedule a time to talk with one of our Mitzvah Project Central educators. We are excited and waiting to hear from you! During this meeting, we will walk you through how to use our online portal of curated mitzvah projects and come up with the perfect project for you!

Dear Parent / Guardian,

We will be collecting some data from your child to best inform their mitzvah projects. To do that, we need you to fill out this Consent Form:

I have read, or I am familiar with, the Child Online Privacy Act (COPPA).

I permit Tzedek America to use the personal information of my student needed to utilize the programs and apps for instructional purposes.

I have read, understand, and agree to abide by the provisions of Tzedek America's Responsible Use Guidelines.

We will not share your information. See our privacy policy.

We are looking forward to getting started!

Warmly,

Your friends at Tzedek America
B'nai Mitzvah Student Information
B'nai Mitzvah Student*

First NameLast Name
B'nai Mitzvah Date*

MonthDayYear
Student's Pronouns (Not sure? Learn about pronouns here: https://www.keshetonline.org/resources/whats-in-a-pronoun/)*
Student's Email Address
example@example.com
Student's Phone Number (*will only be used to send reminders for office hours)
Please enter a valid phone number.
Phone Carrier
Phone Carrier
Synagogue Name (if non-affiliated, type N/A)*
How did you learn about Mitzvah Project Central? (Select all that apply)*

Internet SearchRecommended by a friendRecommended by a clergy memberRecommended by a Tzedek America team memberInstagramLinked InFacebookI have a child who previously participated in Tzedek America programmingOther
What type of mitzvah project are you interested in participating in? (Check all that apply)*

Volunteering TimeRaising MoneyCollecting Items & Delivering ThemI am not sureOther
What topics are you interested in? (Check all that apply)*

Animal WelfareArts & EducationCriminal JusticeDisability InclusionEnvironmental Justice & Climate ChangeFood Insecurity & HungerFoster YouthGender EqualityGlobal IssuesGun Violence PreventionHealth & WellnessHolocaust EducationHonoring Older AdultsImmigration JusticeLGBTQIA+LiteracyMental Health AwarenessPoverty & HomelessnessRacial JusticeUnderserved YouthZionismI am not sureOther
If you clicked "Other", please tell us about what you are interested in.
Bonus Points: Do you already have an idea in mind of what you want to do for your mitzvah project or something you're interested in you might want to turn into a project?
Where have you volunteered before? (More than okay to say that you have not!)*
Parent / Guardian Information
Parent / Guardian's Name*

First NameLast Name
Parent / Guardian's Email Address*
example@example.com
Additional Parent / Guardian's Name (Optional)

First NameLast Name
Additional Parent / Guardian's Email Address (Optional)
example@example.com
Parent / Guardian's Cell Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If there are any accommodations that would help your student participate more effectively, please name them here. If none, please write N/A*
Please add a picture of the B'nai Mitzvah Student so we can see their face*
The cost of Mitzvah Project Central is $200 per student. You will recieve a payment link via Bill.com.*

I agree to pay the $200 fee for this program prior to my child's first meeting with Mitzvah Project Central. I understand that my meeting may be cancelled if a payment in not received.
Parent / Guardian's Signature*

Clear
Today's Date *

MonthDayYear
If you have any questions whatsoever, we are here to help you.

Feel free to reach out to the Mitzvah Project Central team at mpc@tzedekamerica.org.
Should be Empty:

B'nai Mitzvah Student Information

Parent / Guardian Information