Temple Concord Census

Transcription

1 Membership Date: Temple Concord Census Membership ID: (Office Use ONLY) Basic Information Example Adult 1 Adult 2 Name (Title, First, Middle, Last) Dr Jonathan Albert Smith Preferred Name Jon Gender Male Birthdate (mm/dd/yyyy) 11/20/1970 Cellular Phone (xxx-xxx-xxxx) Address jon@gmail.com Household Information Example Adult 1 & Adult 2 Family Name Jon Smith & Betty Jones Betty & Jon Smith Betty & Jon Jones-Smith Street Address 5 Tree Way, Apt 2 City, ST Syracuse, NY Zip Home Phone (xxx-xxx-xxx) Marital Status Married Anniversary Date August 1, 1995 Education/Work Example Adult 1 Adult 2 Degrees Attained Colleges Attended BA Mechanical Engineering Rensselaer Polytechnic Institute

2 Education/Work (continued) Example Adult 1 Adult 2 Occupation Engineer Employer Veridian Dynamics Office Phone (xxx-xxx-xxxx) Office Street Address 123 Main St, Suite 2 City, ST Syracuse, NY Zip Code Religious Tradition Example Adult 1 Adult 2 Parental Tradition Conservative Bris / Baby Naming / Conversion Bris Date (mm/dd/yyyy) 12/1/1970 Hebrew Name Joseph Presiding Rabbi Rabbi Israel Levy Congregation Beth El Location Springfield, CT Religious School (Attended/Did Not Attend) Attended Bar/Bat Mitzvah (Yes/No) Yes Confirmation (Yes/No) No Jewish Camp (Yes/No) (if Yes specify) No Temple Youth Group (Yes/No) Yes Previous Temple Affiliation (if any) along with City, ST Sharei Tzedek New York, NY

3 Children Info INCLUDE Adult Children Example Child 1 Child 2 Child 3 Child 4 Name (First, Middle, Last) Jennifer Emily Jones-Smith Nickname Jen Gender Female Birthdate (mm/dd/yyyy) 4/25/2001 Address jen@gmail.com Bris / Baby Naming / Conversion Baby Naming Date (mm/dd/yyyy) 5/1/2001 Hebrew Name Presiding Rabbi Jael Rabbi Ben Heiman Congregation Sharei Tzedek Location New York, NY Name of School (if Hebrew Day student) School Occupation (if an adult) N/A Street Address (if different) 2 Hill Court City, ST Syracuse, NY Zip Concord Member Past or Present Yes Name of Spouse N/A Children (of each child) N/A

4 Extended Family Tree Adult 1 Name (First, Last) City, ST of Residence TC Member Date of Birth Date of Death Example Sandy Silverstein Palm Springs, FL Former 7/2/ /1/1999 Grandchildren Siblings Parents Grandparents Other (specify) Adult 2 Name (First, Last) City, ST of Residence TC Member Date of Birth Date of Death Example Sandy Silverstein Palm Springs, FL Former 7/2/ /1/1999 Grandchildren Siblings Parents Grandparents Other (specify) Please feel free to add additional information on a separate page.

5 Skills & Talents: Please check all that apply. Where appropriate, include specifics. Name Adult 1 Adult 2 Child 1 Child 2 Child 3 Child 4 Art Appreciation Arts & Crafts Cooking Creative Writing Graphic Design Journalism Judaic Studies Language Skills: Hebrew Language Skills: Other (specify) Musical Instrument (specify) Painting Photography/Video Sewing/Needlecraft Singing Teaching Theater Arts Computers Networking/IT Website Design & Development Youth Work Other

6 Interests & Activities: Please let us know what you would like to learn more about. Description Adult 1 Adult 2 Children Brotherhood Seasoned Citizens WRJ XCon TYCon JYG Budgeting and Finance Volunteer Choirs Fundraising Judaica Shop Office Volunteer Temple Theater Torah Study and Minyan Youth Adult Education Helps create classes and learning opportunities for adults Blood Drive Helps run our annual blood drive Building and Grounds Helps maintain our beautiful sanctuary Caring Community Reaches out to those in need College Outreach Helps connect with our college students and SU students Food Pantry Helps feed the hungry in our community Holidays and Festivals Helps plan and run celebrations at the Temple Interfaith Outreach Helps connect interfaith families with Jewish living Library Helps maintain and build our library and media center Outreach Reaching out to the unaffiliated Publicity Works with the marketing and membership committee Rakov Museum Helps preserve the history of Temple Concord Social Action Helps promote social justice in the Temple Social and Cultural Events Helps plan and coordinate fun events Temple Ambassador Welcomes and mentors new members of Temple Concord Transportation Helps arrange rides for Temple events Tzedakah Helps collect charity and encourage giving Ushering Welcomes all to services and programs