iEngage Request Form for Leaders

Please use this form to request access to iEngage materials for leaders. Upon completion of the form, you will gain access to Hartman Connect, our online platform where the course materials can be viewed and shared with your participants.

If you have any issues, please contact Shaanan Miller, shaanan.miller@shalomhartman.org.

Personal Information

Title

First Name

Last Name

Phone:

Please make sure your email address is spelled correctly.

Your Job Title:

I am a (check all that apply):

Jewish educatorClergy member

Select Synagogue/Organization From the list below:

If not in the list please check "Synagogue/organization Not listed" below

Synagogue/organization Not listed

Synagogue/Organization Name

Synagogue/organizational affiliation:

Conservative	Just Jewish
Modern Orthodox	Non-denominational
Orthodox	Reconstructionist
Reform	Renewal
Traditional	Other:

If other, please specify.

Primary Professional Setting

CampCollege Campus / HillelSynagogueJewish Day SchoolJewish Non-ProfitCommuity CenterHospital / Healthcare SettingOther:

Other (please specify):

Address

Country

State/Province

State

Province

City

Postal Code

US Postal Code

Canadian Postal Code

Geographic Region

iEngage

Have you taught iEngage in the past?

YesNo

If so, which course(s) - check all that apply:

Volume 5: Together and Apart: The Future of Jewish PeoplehoodVolume 4: Israel's Milestones and Their MeaningsVolume 3: Jewish Values and the Israeli-Palestinian ConflictVolume 2: The Tribes of IsraelVolume 1: Foundations for a New Relationship

Assistant Information

Course materials are accessed online. If you have an administrative assistant who will need to access the materials on your behalf, please provide their information below so that we can grant them access to Hartman Connect.

Assistant First Name

Assistant Last Name

Assistant Email

Job Title

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