Connection Point School Application - 5780
Dear Principal,

Welcome to the application for Connection Point - Year 5780. Below are the items needed to complete your application.

Please fill out the entire form.

If you need assistance, please do not hesitate to reach out to lplotkin@jemedia.org.

Thank you!
Email address *
Information
Your name *
Your answer
School *
Your answer
City, State *
Your answer
Principal's Phone Number *
Your answer
Number of Students in 5th and 8th grades *
Important for number of prizes, question sheets, etc.
Your answer
Boys or Girls School *
The program is for both boys and girls from 5th through 8th grades. If your school has more than one division, a separate application should be filled out for each. (If your school is small, please contact us to discuss.)
Representative and Viewing Information
Who will be your CP Representative? *
This person will run Connection Point at your school. They will be in contact with us to coordinate. They must be excited and passionate about the program, and ready to invest the time and effort to make it the best it can be. Please recommend someone for this position, with whom we will be in touch if your school is accepted into the program.This person can be the principal, but it does not have to be.
Your answer
Phone Number for School Representative?
If different than principal.
Your answer
Email address for School Representative?
If different than principal.
Your answer
Who will be the person of authority present at the rallies? *
The program will be successful only if the environment is under control, and the students behave appropriately. If the Connection Point Representative is the principal or someone else who can have adequate control, than that is enough. If not, than the principal should be present during the program.
Your answer
Do you have the proper equipment to show the rally? *
A big part of helping the students focus is to make sure you have the proper equipment to show the video. Please check the items that apply
Required
Do you want the program in Yiddish?
If all or some of your students will need Yiddish material, please tell us the number of children requiring Yiddish.
What subtitles do you want on your DVD?
Will your school be a Connection Point Affiliate?
By becoming a Connection Point Affiliate besides for getting a cheaper price you get to enjoy all the perks that come along with it, see the email attachment for more info.
Payment
Cost to Participate *
One rally - $600 per rally. Two rallies - $500 per rally. Three rallies - $400 per rally. Connection Point Affiliates $350 per rally. For information on additional costs for extra viewings, see attachment.
Required
Payment Method *
Payment Method for Affiliates
Do you have a sponsor? if yes please supply the information
Your answer
Contact for Payment
Please include a way to reach the person if you choose other
Will you School be doing Pickup or Shipping?
If shipping, fill in address here
Note that your credit card on file will be charged for shipping
Your answer
Pictures *
Feedback *
Please provide any comments or suggestions
Your answer
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This form was created inside of Jewish Educational Media.