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Course Request Form - Personal Information:
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* Indicates required question
Name of Student:
*
Your answer
Student's Email:
*
Your answer
Parent/Guardian's Name:
*
Your answer
Parent/Guardian's Email:
*
Your answer
Parent's Phone Number:
*
Your answer
Current School Grade:
*
Choose
3
4
5
6
7
8
9
10
11
12
I am interested in registering for:
*
Choose
Year-long course
Semester-long course
Short-Term academic support/tutoring
Please provide a specific course name. You can refer to the Bonim B'Yachad course catalog (
https://www.bonimbyachad.org/course-catalog
)
*
Your answer
Do you have a curriculum and text for this course, or do you want Bonim B'Yachad to supply the learning materials?
*
I have the curriculum
I want Bonim B'Yachad to supply the materials
I prefer to take this course alone (1 on 1) or with up to 2 other students:
*
1 on 1
With others
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