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Havurah Profile

First Name *

Last Name *

Spouse/Partner's Name (if also participating)

Email Address *

Phone Number (xxx-xxx-xxxx) *

Which category describes you best? *

Single without children

Single parent with children

Couple with children

Empty Nester

Senior (65+)

Please rate your interest from 1=Not at all interested to 5=Extremely interested in a Havurah that focuses on:

Jewish study *

1

2

3

4

5

Celebrate Shabbat/Jewish Holidays *

1

2

3

4

5

Current event/book discussions *

1

2

3

4

5

Adult social gatherings/recreational activities *

1

2

3

4

5

Social action/community service projects *

1

2

3

4

5

Interfaith family issues *

1

2

3

4

5

Children-oriented/family activities *

1

2

3

4

5

Considering your interests, how important (from 1=Not at all important to 5=Extremely important) is it for the Havurah to have:

Adults that are in the same category (see above) as you *

1

2

3

4

5

Adults who have children of similar ages to yours *

1

2

3

4

5

Do you consider yourself a planner/organizer? *

Yes

No

Would you be willing to host the initial Havurah meeting? *

Yes

No

Are there any TBE members you would like to see in your Havurah? If yes, please list their names.

Is there any other pertinent information that would help in placing you in a Havurah?

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