BJX COLLEGE LEADERSHIP COURSE

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

LEARN SUCCESS! MEET POWERFUL CEOs. QUALIFY FOR INTERNSHIPS. EARN $275. RECEIVE A DIPLOMA UPON CONCLUSION. WE MEET 7:30pm- 9:40pm at BJX 2915 Ave. K BEGINS MONDAY Feb 26. Apply today!!

Jewish Students- College Leadership Course

First name? *

Last name? *

Your email? *

We keep all info private

Who referred you? *

Please specify.

Whats your cell #? *

We may need to reach you. We promise that we won't share it:-)

Which High School did you attend? *

Please specify. Tell us what year you're in.

Which College are you attending? *

Please specify. Tell us what year you're in.

Is your mother Jewish? *

We do not share any of your information.

Yes, she was born Jewish

She converted to Judaism

No, she is not Jewish

What are the ages of your siblings? (Please specify i.e. my brother is 10 and my sister is 20) *

We do not share any of your information.

How did you find out about this course? (please be specific (i.e. Eric Shrem told me about it) *

What are your hobbies? Did you receive any awards/scholarships? *

We do not share any of your information.

We require that you submit a recent photo of yourself. Please submit it now. *

Email photo to info@bjxcenter.com

I Just emailed my photo. Thanks!

I will email my photo within 24 hours. Thank you.

Please type your full address and your d/o/b *

All info is kept strictly confidential.

Please join our Whats App Group *

This is how we stay in touch. Text "Leadership Course & your name" to 718-809-4574 to join.

Just did! I want to know all about what's going on!

Required

Please provide Name and Cell phone of Emergency contact *

Mom

Dad

We require a one-time $50 (non-refundable) payment. Pay here: BJX Payment Page (merchpay.com). $50 will be added to your stipend upon FULL attendance to the complete 6 weeks & the weekend Shabbaton. *

I submitted the $50, please confirm my spot!

Thanks, but I'm not taking the Leadership Program

Name and Cell phone of Emergency contact *

By applying for the Leadership course I agree to come for 6 weeks & attend a local "spectacular" Weekend by BJX Ave. K with the CEOs at the end of the program. *

It will take place in Midwood/hosted at BJX with full hospitality and lodging. Failure to attend will disqualify you from receiving your stipend.

By checking this box I understand that to receive my stipend I must attend the 3 Gourmet Meals & Exclusive Weekend.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms