Please fill out this form as completely and accurately as possible. You’re encouraged to use the Narrative portion of the form to round out your description, especially if you don’t see a good answer or category for your group. Please know that your form will be reviewed by Culture Connect staff before it’s published; they will contact you with any questions or issues that need clarification. Thank you.

Discipline (select the category/categories below that best describe your work):

Services Your Provide (select all that apply):

Age/Demographic Group/s Served (select all that apply):

Please provide a brief narrative description of your organization’s work (150 word max):

Name & Contact Info for person completing the form:

Same as Contact person

Agreement

I agree to be listed in the Culture Connect Resource Directory on www.JewishCultureConnect.com and give permission to publish this information.