Challenges and Choices Mussar Facilitation Training Program Application Form 2022-2023

Trainee applicant information to be completed below.

Please complete one form for EACH trainee applicant from your site.

* indicates required field

Organization Name (Synagogue, Camp, JCC, etc.) Prefix First Name Middle Name Nickname Last Name Email Phone Phone Type Address Type Address Line 1 Address Line 2 City State/Province (USA/Canada) Territory (all other countries) Zip/Postal Code - Country Timezone Religious Denomination Number of sites (please enter 1 here)

Include myself as a contact

I want to facilitate this Mussar program to teens

Teen Program Interest

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