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Machon Chana Alumnae Registration Form

Submit your personal details to be included in the Alumnae Directory & Alumnae Resource Networking Book.

Please press TAB or use your mouse to move from one field to the next.

I am submitting for:
Self Lost Alumnae

This name is listed in:
Alumnae Directory
Lost Alumnae Directory
Neither Directory

This submission is:
New Update

Key/ID number:
(if not from Lost Alumnae List, type "N/A")

Program (s) attended?
Full-time Part-time YeshivaCation
Summer Evening Sunday

First Name:

Last Name:

Hebrew Name:

Name to appear on mailing list:
Hebrew First Name

Spouse's Name:

E-Mail address:

Mailing address:

City:

State:

Postal/Zip Code:

Country:

Home telephone number (s):

Home fax number (s):

Business telephone number (s):

Business fax number (s):

Cell number:

Maiden Name:

Occupation:

Expertise:

Talents:

Year(s) at Machon Chana:

Alumnae Survey

1) Religious Affiliation:
Anash
Non Chabad Chassidim
Litvish or Yeshivish
Modern orthodox
Not Frum
Other:

2) I attend a weekly shiur I attend Shiurim regularly

3) I have a mashpia I need a mashpia

4) I have a Rav I turn to for advice

5) I live in a frum community

6) Martial Status:

Single

Married

Divorced

Widowed

Family Situation

7) Parents:

elderly Young Deceased

8) Family Level of Acceptance:

Happy that I'm frum Accepted who I am Resentful

9)Husband:

We are on the same frumkeit level

Goes to Shiurim

Has a mashpia

10)Children:

Number of children:
How many Girls? How many Boys?

11)Grandchildren?
Yes No If yes, how many?

Schools

12)Your children attend (or attended)?

Financial Situation

13)Husband's occupation:

14)Financial Status:

B"H very well off
B"H well off
making it
barely making it
out of a job

Networking

In what areas can you offer help or advice to others?
Cooking / Baking

Organizational skills

Child rearing

Teaching

Building social skills / Self esteem

Shadchanus

Fundraising

Event planning

Fundraising

Diet

Health issues

Alternative medicine

Job search

Apartments / Roommates search

Yeshiva search

Legal advice

Home decorating

Entertainment

Shalom Bais

Halachic issues

Hashpaa

Addictions

Coping skills

Community involvement

Aging

Chevrusa learning

Other

I can use help in the following areas:

Cooking / Baking

Organizational skills

Child rearing

Teaching

Building social skills / Self esteem

Shadchanus

Fundraising

Event planning

Fundraising

Diet

Health issues

Alternative medicine

Job search

Apartments / Roommates search

Yeshiva search

Legal advice

Home decorating

Entertainment

Shalom Bais

Halachic issues

Hashpaa

Addictions

Coping skills

Community involvement

Aging

Chevrusa learning

Other

24)Question or Comments?

25)Submitted by

26)Best time to Contact me