Shalom! You're Home Intake Form

Whether you are new to Sarasota-Manatee or new to us at the Federation, we want to know you! Our Shalom! You're Home program can help you get settled, get involved and make new friends!

Contact us!

Lauren Cohen | 941-706-0027 or Lcohen@jfedsrq.org
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this a temporary address?

No, this is our new home address in Sarasota or Manatee countyYes, we expect to move to a different permanent address in Sarasota or Manatee countyYes, we rent seasonally and our address may change from year to yearOther
Which community are you moving from?*
Birth Date (for security purposes)*

MonthDayYear
Date
Are there other members in your household?*

YesNo

Are you retired?*

YesNo
What was your former profession?*
What is your current profession?*
Tell us your interests (check all that apply)*

IsraelCultural Arts: Books, Movies, Music, Museums, etc.HolocaustChild and Family Programming (PJ Library, STEP, Camp, etc.)SecurityAntisemitismCommunity News and InformationJewish FoodJewish HolidaysTravel and Day TripsJewish EducationVolunteer OpportunitiesTeen ProgrammingSocial Events
Would you like to join the Federation's weekly email list?

YesNo
Would you like to receive the Federation's weekly E-Newsletter?

Yes, subscribe me to the weekly e-newsletter!No, thank you!
Would you like to receive the Federation's weekly E-Newsletter?

Yes, subscribe me!No, thank you!
Would you like to receive our free, monthly newspaper, The Jewish News?

Yes, please!No, thank you!
Should we send The Jewish News to the same address as above?

YesNo
Where should we send The Jewish News?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: