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Jofa S.A.F.E. Plan: Abortion Access Form
Name
(Required)
First
Last
Please confirm that you are 18+ years old:
(Required)
Yes
No
Preferred Email Address
(Required)
Phone Number (Best Phone Number to Contact You)
(Required)
City of Residence
(Required)
State of Residence (Please Provide Abbreviation)
(Required)
I am seeking support resources for:
(Required)
Myself
Someone Else
I am seeking support for the following (Please check all that apply):
(Required)
Pastoral guidance
Peer support
Funding
Travel logistics
Educational resources
Other (If checked, please add details in next question)
If you checked "Other" above, please describe here:
There are growing local support networks in Orthodox Jewish synagogue communities across the United States. Would you like to be connected to one of those communities? If so, please indicate your preferred city/cities below.
To the extent that you are comfortable sharing, please tell us briefly and confidentially if you have lived experience with any aspect of abortion care, whether yourself or someone close to you, that would be relevant to this project?
