GENuine Connections Teen Registration Form

GENuine Connections New Youth Volunteer Application 2023-2024
Thank you for your interest in the GENuine Connections.

Application Process:
- Complete this application. Any questions that are not pertinent to you may be left blank.
- Register and attend your zoom orientation
Please note: if you have participated as a Teen Intern in the past, you do not need to complete this application.

Contact us at GENuineconnections@dorotusa.org with any questions.
Name*

First NameLast Name
E-mail*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Birth Date*

MonthDayYear
Home phone
Gender*
What pronouns do you use? (Choose all that apply)

she/her/hershe/him/histhey/them/theirsOther (please add below)
Pronouns (if not listed above)
Please describe yourself. Check all that apply: (For demographic purposes only, please select all that apply)

WhiteBlack or African AmericanHispanic, Latino or Spanish originAsianAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslandPrefer not to answerOther
If Other, please specify:
Do you consider yourself to be...? (For demographic purpose only, please select all that apply)

ChristianJewishMuslimBuddhistHinduIndigenous ReligionAgnosticPrefer not to answerOther
If Other, please specify:
I speak the following languages in addition to English. Choose ALL that apply:

American Sign Language (ASL)ArabicCantoneseFrenchGermanHebrewHungarianItalianMandarinPolishRomanianRussianSpanishYiddishOther
Other Language(s) Spoken:
Name of School you attend
Type of School
Grade*
*We only accept 9th - 12th grade, High School Students to the program.
Are you an alum of any of these DOROT programs? If so – check all that apply*

Summer Teen Internship ProgramAcademic Teen Internship Program (interned during the school year)Chess ProgramVolunteered with DOROT through my schoolNo, I have not participated in any of these programs
Parent or Guardian Information
Parent or Guardian Name

First NameLast Name
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
Employer
Occupation
Business Phone Number
Home Phone Number
Parent or Guardian 2 Name

First NameLast Name
Email
example@example.com
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number

Area CodePhone Number
Employer
Occupation
Business Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
I heard about GENuine Connections through*

ParentSiblingGrandparent or GrandrelativeOther FamilyFriendSynagogue/church/mosque/place of worshipSchoolCommunity GroupMedia outlet (newspaper, radio, TV)UJA/FederationSocial MediaDOROT E-mailDOROT websiteGoogle websiteVolunteer Match websiteIdealist websiteNYC Service websiteMommy Poppins websiteTime Out Kids NY websiteOther
What motivates you to apply for GENuine Connections? * *
Next Steps:
Once you submit this form, you will be redirected to register for a Zoom Orientation. Please choose a date that works for you!

Contact genuineconnections@dorotusa.org with any questions.

Thank you again for your interest in GENuine Connection.
Should be Empty:

GENuine Connections New Youth Volunteer Application 2023-2024

Next Steps: