NEXT Summer Class Registration for Philadelphia Teachers Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Age (for demographic purposes) Younger than 18 18 - 24 25 - 30 31 - 39 40 - 49 50 - 54 55 - 59 60 - 64 65 or older Question Title * 4. Gender (for demographic purposes) Question Title * 5. Ethnicity (for demographic purposes) Nonresident Alien Black or African American American Indian/Alaska Native Asian Hispanic of any race Native Hawaiian or other Pacific Islander Race and Ethnicity unknown White 2 or more races Question Title * 6. Email Address Question Title * 7. Phone Number Question Title * 8. Street Address Question Title * 9. City and State Question Title * 10. Zip Code Question Title * 11. At which Supplementary School(s) do you expect to teach during the 2013-2014 school year? Please select all that apply. Adath Israel of the Main Line, Merion. Temple Beth Ami, Northeast Philadelphia. Beth Chaim Reform Congregation, Malvern. Beth David Reform Congregation, Gladwyne. Beth Israel Congregation of Chester County, Eagle. Beth Sholom Congregation, Elkins Park. Beth Tikvah-B’nai Jeshurun, Erdenheim. Community Torah Center of Bucks County, Richboro. Congregation Adath Jeshurun, Elkins Park. Congregation Beth Am Israel, Penn Valley. Congregation Beth El of Lower Bucks County, Yardley. Congregation Beth El-Ner Tamid, Broomall. Congregation Beth Israel of Media, Media. Congregation Beth Or, Maple Glen. Congregation B’nai Jacob, Phoenixville. Congregation Brothers of Israel, Newtown. Congregation Hesed Shel Emet (“Mercy and Truth”), Pottstown. Congregation Kol Ami, Elkins Park. Congregation Kol Emet, Yardley. Congregation Mikveh Israel, Philadelphia. Congregation Mishkan Shalom, Manayunk. Congregation Ohev Shalom, Wallingford. Congregation Or Ami, Lafayette Hill. Congregation Or Shalom, Berwyn. Congregation Rodeph Shalom, Philadelphia. Congregation Tiferes B’nai Israel, Warrington. Congregation Tifereth Israel of Lower Bucks County, Bensalem. Germantown Jewish Centre, Philadelphia. Har Zion Temple, Penn Valley. Jewish Children’s Folkshul, Chestnut Hill. Jewish Community High School of Gratz College, Melrose Park Jewish Teen Collaborative, Elkins Park Kehilat Ha’Nahar, The Little Shul by the River, New Hope. Kesher Israel Congregation, West Chester. Kol Tzedek, Philadelphia. Main Line Reform Temple-Beth Elohim, Wynnewood. Narberth Havurah, Narbeth. Ohev Shalom of Bucks County, Richboro. Old York Road Temple-Beth Am, Abington. Or Hadash: A Reconstructionist Congregation, Fort Washington. Reform Congregation Keneseth Israel, Elkins Park. Reform Congregation Keneseth Israel, Blue Bell. Temple Beth Hillel/Beth El, Wynnewood. Temple Beth Zion-Beth Israel, Philadelphia. Temple Brith Achim, King of Prussia. The Congregations of Shaare Shamayim, Northeast Philadelphia. Shir Ami Bucks County Jewish Congregation, Newtown. Society Hill Synagogue, Philadelphia. Temple Judea of Bucks County, Doylestown. Temple Sholom, Broomall. Temple Sinai, Dresher. Tiferet Bet Israel, Blue Bell. Other (please specify) Question Title * 12. If you know what topics you will be teaching in the 2013-2014 school year, please list them in the space below. Question Title * 13. If you know what grades/ages you will be teaching in the 2013-2014 school year, please list them in the space below. Question Title * 14. If you would like us to let your supervisor know when you have completed the class(es) for which you are registering, please enter that person's name and email address in the space below. Next