ADL Basic Form Template
Report Card
First Name
Last Name
Zip Code
Which Report Card college or university are you affiliated with?
Max character limit is 255
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Are you a current student, alumni, staff or faculty member at this college or university?
Student
Alum
Staff or Faculty Member
If alum, which year did you graduate?
Current university or alum email address
How would you describe your experience with Jewish life on this college's or university campus?
If you have experienced or witnessed antisemitism on this college's or university campus please describe your experience(s) below.
Is there anything else you would like to add?
Would you prefer for your response to remain confidential?
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