Student Info Update/Raffle
Student Name:
Gender:
Mailing Address:
(during semester)
City / State:
Phone Number:
Email:
Birthday:
AIM Screen Name :
Parental Contact:
Address:
Same As
Above
City / State / Zip:
Phone Number:
Parent's Email:
Major:
Expected Graduation Date:
Affiliation:
Just Jewish
Orthodox
Conservative		 Reconstructionist
Reform
Humanist		 Secular
Not Jewish
Other:
What cool things are you interested in?
Alternative Spring Break
Community Service/Volunteer
Film/Theater
Israel Activism
Israeli Culture
Trip to Israel
Jewish Learning:
     Subject Suggestion?  		 LGBTA
Music
Outdoor Activites
Political Activism
Professional Networking
Shabbat/Holiday Celebrations
Social Events
Sports


Have you ever been to Israel? No Yes
(If Yes, Reason for Trip?)


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