Please enter in your identifying information to access your records with Kesem.

This form is designed to collect and update contact information for members of the Kesem community who identify as one of the following:

A former youth participant: Anyone who attended Kesem as a camper or took part in Kesem programs as a child.

A former student leader: Anyone who participated in Kesem programs in a volunteer role— such as counselor, coordinator, or general member.

Please select the option(s) that best describes your current involvement with Kesem

I am a former camper/youth participantI am a former student leaderI am a current student leaderI am an Advisory Board member

If you feel that none of these options represent your current/past Kesem experience, please contact us here for support.

Which chapter did you participate with as a camper/youth?

Which chapter have you participated with as a student volunteer?

First Name

Last Name

Previous Last Name (if applicable)

Birthdate(mm/dd/yyyy)

Mobile Phone

Opt-in to receive text messages

Yes

Email (please enter a non .edu email address)

Mailing Country

Mailing Street (include apt. #)

City

State

Zip/Postal Code

Province

Address Type

Undergraduate University:

Undergraduate Graduation Year:

Graduate Institutions

If selecting multiple institutions you will need to select the second option while holding command(Mac) or control(Windows)

Please select the sector that aligns with your occupation or field of study.

Employer Name

Job Title

Are you interested in hearing more about volunteer opportunities?

YesNo