| Personal Information | ||
| *First Name | ||
| *Last Name | ||
| Student Id # | ||
| Gender |
Male Female |
|
| Birthday |
Year: (e.g. 1978) |
|
| Major(s) | ||
| Current year in school | ||
| Expected Graduation Date | ||
| Would you like to receive weekly Hillel updates by e-mail? |
| School Address | ||
| School | ||
| *Street | ||
| Aparment or Room # | ||
| *City | ||
| *State |
in United States |
|
| *Zip Code | ||
| *Phone | ||
| Cell/Pager | ||
| Permanent Address | ||
| * Street | ||
| * City | ||
| * State |
in United States |
|
| * Zip Code | ||
| * Parent’s Names | ||
| * Parent’s Phone | ||
| Hillel Interests: | |
| Career Networking | |
| Community Service/Social Action | |
| Cultural/Arts | |
| Gender and Sexual Orientation Issues | |
| Graduate Student Groups | |
| Holocaust Education/Programming | |
| Israel Programming | |
| Jewish-Hispanic | |
| Jewish Philanthropy | |
| Jewish Learning Opportunities | |
| Leadership | |
| Outdoor/Adventure Activities | |
| Political Activism | |
| Religious/Spiritual | |
| Shabbat/Holiday Celebrations | |
| Social Events/Entertainment | |
| Sports/Intramural | |
| Campus Activities and Interests: | |
| Community Service | |
| Health Awareness | |
| Leadership Organizations | |
| Music | |
| Student Government | |
| Politics | |
| Sports | |
| Theatre/Cultural | |
| Gender Issues | |
| Fraternity/Sorority | |
| Name | |
| Other (enter below) |
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