Afrika Tikkun Alumni Registration Form
First Name: *
Your answer
Surname: *
Your answer
Gender: *
Birth date: *
MM
/
DD
/
YYYY
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? *
Required
Which Afrika Tikkun Centre(s) did you attend? *
Required
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? *
Required
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: *
Required
How would you like to stay connected to Afrika Tikkun? (Tick all that apply)
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