Afrika Tikkun Alumni Registration Form
First Name: *
Your answer
Surname: *
Your answer
Gender: *
Birth date: *
What is your ethnicity: *
Please add 3 phone numbers below so we can always have a way to contact you. These could be your cellphone number, a number of your close family member or neighbour, or a phone number of a close friend. These should be people who can get in touch with you easily, should one of the other numbers not work.
Phone Number 1: *
Your answer
Phone Number 2: *
Your answer
Phone Number 3: *
Your answer
Email address: *
Your answer
Where do you live now? Please state the area. *
Your answer
Your Afrika Tikkun Experience
Which Programme(s) did you take part in or access while you were at Afrika Tikkun? *
Which Afrika Tikkun Centre(s) did you attend? *
What year did you graduate from Afrika Tikkun? *
How old were you when you graduated from Afrika Tikkun? *
How satisfied are you with the overall experience you had at Afrika Tikkun? *
Very Dissatisfied
Very Satisfied
Tell us about your life after Afrika Tikkun
What is your highest qualification? *
What is your current employment status? *
If you are working or studying, what is the name of the Company or University/College?
Your answer
Get involved, make a difference
Considering your experience with Afrika Tikkun, would you consider contributing in any of the following ways: *
How would you like to stay connected to Afrika Tikkun? (Tick all that apply)
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service