info@jimena.org

J I M E N A
(415) 626-5062

Sarah Levin – Executive Director
sarahlevin(AT)jimena.org

Natalie Farahan – Los Angeles Program Director
natalie(AT)jimena.org

Analucia Lopezrevoredeo – San Francisco Program Director
analucia(AT)jimena.org

 

Contact JIMENA!

Contact Form

Section I

(TO BE COMPLETED BY PERSON FILLING OUT THIS REGISTRATION CARD)

Name*:

Address:

City, State:

ZIP code:

Country*:

Home Phone Number:

Cell Phone Number:

Email Address:

If you are filling this out for someone else, what is your relationship to them:

Section II

Family Name:

First Name:

Maiden Name or Other:

Section III

Country of origin- Checkmark one that applies:
 Aden Algeria Egypt Lebanon Libya Morocco Iran Iraq Sudan Syria Tunisia Yemen

Name of Village, Town or City in Country of Origin:

Occupation:

Year of Departure:

Where did person go after leaving country of origin?

How long did they stay there?

Where did they finally resettle?

Please list any assets confiscated or abandoned in the country of origin.

Family Assets (homes, business, property, bank accounts, pensions, etc.):

Communal Assets (synagogues, schools, cemeteries, mikvas, etc.)

Would you be willing to be interviewed about your family history/experience?  Yes No