Jnetics on Campus
Student Reps

Thank you for your interest in being a Jnetics on Campus University Rep. Please fill out the form below and a member of the Jnetics team will be in touch with you shortly.

"*" indicates required fields

Name*

Title First Last

Date of Birth*

Mobile*

Email*

Home Address*

Street Address City County / State / Region ZIP / Postal Code

University Address*

Your address while at University.

Street Address City County / State / Region Post Code

University/Higher Education Institute*

Year of Study*

Student ID*

University Course*

Have you been tested through Jnetics before?

Yes

Where and when were you tested?

Are you involved in your university JSoc?*

Yes

As a rep, how would you help Jnetics to raise awareness of our Jnetics on Campus – University Screening Week event and encourage students to sign-up?*

What is your availability to meet with a member of the Jnetics team?

About Jewish Genetic Disorders →

Dominant Disorders

Recessive Disorders

Jnetics on Campus
Student Reps

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More information

About Jewish Genetic Disorders →

Dominant Disorders

Recessive Disorders

Jnetics on CampusStudent Reps

Jnetics on Campus
Student Reps