CHCH Application
Please fill out to the best of your ability. We will contact you after receiving your application.
Email address *
Applying to Men's or Women's program? *
First & Last Name *
Phone Number *
How did you hear about us? *
Do you have access to a computer? *
Do you have reliable Internet access? *
Describe your computer skills *
What is your goal upon program completion? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Jewish Community Council of Greater Coney Island, Inc. Report Abuse