Shaloh House Community Survey

Dear Friends,

Shaloh House Chabad proudly serves our local community with loving kindness. We continuously evaluate our success to give us a better idea how to serve you best. We would like to ask you to take a moment and fill out our community survey below. As you answer the following questions, please remember, we keep all replies confidential.
Rabbi Mendel & Chana Gurkow
What was your most memorable Jewish experience?
Family Seder at PesachLighting Chanukah CandlesShabbat DinnerVisiting Israel
Is there any one person, past or present, who "lit the spark" that began your Jewish journey?
What inspires you to lead a more Jewish life?
What activity at Shaloh House do you most admire?
Torah StudiesPublic Menorah LightingsJewish Women ConnectCTeenPurim Dinner
Every month Shaloh House sends out Yahrtzeit reminders to families to remember their loved ones. Would you like us to do the same for you?
Please include persons English name and Hebrew name with Fathers Hebrew name.
MonthDayYear
at HourMinutes
Which one of these Mitzvot would you like to learn more about?
Learning about Kashrut (keeping kosher)The laws of Family PurityHow and why to light the Friday night candlesWhy we put a Mezuzah on our doorDeath & Mourning
Are you or a loved one undergoing a major medical procedure within the next few months? Can we offer support to you and your family?
Are you interested in helping out at Shaloh House?
To be called upon for a Minyan when neededPreparing the Shabbat KiddushVisiting the houseboundBaking challah for the elderly
Have you ever been to Israel? Would you be interested in joining Shaloh House on a community trip to Israel?
I have not been to Israel and I'm interested in joining a community trip.I have already been to Israel and I'm interested in joining a community trip.I am not interested in a community trip to Israel at this time.
Do you have a child or grandchild away at college? Let Shaloh House invite your student to enjoy Shabbat dinner, meet new friends, and renew Jewish values. Please share their information and we will do the rest.
Many people like to leave a gift to charity in their will. Would you consider leaving Shaloh House in yours?
I have already included Shaloh House in my will.I would definitely include Shaloh House in my will.I would probably include Shaloh House in my will.I would like to speak to someone about including Shaloh House in my will.I am not interested at this time.
What would you suggest we do to enhance the success of Shaloh House?
Full Name*
First NameLast Name
Birth Date
MonthDayYear
E-mail
Phone Number
Area CodePhone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Marital Status
MarriedSingleDivorcedLooking for a Shidduch!Widow/Widower
Age of Children
0-1213-1718-3030-60No Children
Should be Empty:

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