Parent contact form for Rutgers Hillel

Guardian Name *

First

Last

Guardian E-mail *

Guardian Phone *

Student Name *

First

Last

Student Email *

Student Phone *

Student Graduation Year *

Student Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you belong to a synagogue? If yes, please include the name.

Is your child eligible for Birthright? (18-26 years old and haven't been on Birthright before) *