Community Impact Network Application

Please fill the out form below

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Name*
MM slash DD slash YYYY
Include your current professional role and/or community participation, background, and what motivates you personally and professionally.
What was the situation, what action did you take, and what was the outcome?
What do you hope to gain from the experience?
This program includes 6 evening in-person sessions over the course of 10 months. What evenings of the week generally work best for your calendar (check all that apply)*

Participant Fee

To help sustain the high-quality programming and community engagement opportunities we provide, this leadership cohort includes a participation fee of $500.

This fee contributes to:

  • Program materials and curriculum
  • Guest speakers and facilitators
  • Delicious kosher dinners
  • JPAC Capitol Summit Conference registration and lodging
  • Attendance to JFSLA’s Annual Gala

We are committed to ensuring that this opportunity remains accessible to all qualified applicants.

Scholarships and payment plans are available, and we encourage you to apply regardless of financial circumstances.

If the fee poses a barrier, please indicate your interest in financial assistance in the application— we’re happy to work with you.

This field is for validation purposes and should be left unchanged.