JVS Workshop Registration

To Pre-Register for JVS Workshops:

1. Complete this form and hit the submit button.

or

2. Complete and print (ctrl P) this form and mail to:

JVS
Attention: Wendy Verba
225 Bush Street, Suite 400
San Francisco, CA 94104

or

3. Complete and fax this form to: (415) 391-3617 / Attention: Wendy Verba

or

4. Drop in during business hours to register at our office

JVS asks for the information below for statistical purposes. These statistics help to secure
future funding for JVS. Your information will be kept strictly confidential.

Last Name

First Name

Address

City

Zip Code

Phone (home)

Phone (cell)

E-mail address

Date of Birth (mm-dd-yyyy)

1. Where did you find out about this workshop? (Check all that apply)

Public agency (e.g., EDD, Human Services Agency, Dept. of Rehabilitation)

(specify)

Jewish organization (e.g., Jewish Family and Children’s Services, synagogue, JCC)

(specify)

School (e.g., City College, SFUSD, community college)

(specify)

Other social service agency or community organization (e.g., Goodwill, Toolworks, CVE)

(specify)

Media (newspaper, internet, radio)

(specify)

Community event (e.g., job fair, street fair)

(specify)

Employer

(specify)

JVS (website, internet, staff)

(specify)

Friend/family member/co-worker

Other

(specify)

2. I am interested in these other services at JVS. Please check all that apply:

Job Search Assistance

Career Coaching

Job search workshops and support groups

English as a Second Language training

Access to computers, printers & job resources

Computer skills building

Occupational job training

(specify)

Youth Services

Other

(specify)

None

3. What is your religion? (OPTIONAL) NOTE: This question is asked for statistical purposes only. Your answer will NOT affect your eligibility for JVS services.

Buddhist Jewish

None Decline to state

Christian Moslem

Other (specify)

4. Do you require any special accommodations? (Please specify and submit all accomodation requests at least 5 business days before the day of the workshop)

5. Please do not add me to your mailing list.