College Outreach Form

Help Us Stay In Touch With Your College Student:

Tikvat Israel wants to stay in touch with your college students. Please fill out this form and submit by Aug. 31.2009.

Student's Name:
College Attending:
Class year:	Freshman Sophomore Junior Senior Graduate Student
Student's Address (U.S. only, please)
Address:

City:	State: Zip Code:
*!! Please notify us if there is a change of address during the year or if the student will not be at the above address for one of the semesters.*
Student's Phone Number:
Student's Email Address:
Student's Birthday:

Parent's Name(s):
Parent's Phone Number:
Parent's Email Address:
Parent's Address
Address:

City:	State: Zip Code:

Yes, I would be happy to help assemble the packages during the year.

Yes, I would like more info about helping to sponsor a package.

Comments:

	Tikvat Israel Congregation 2200 Baltimore Road · Rockville, Maryland 20851 Phone: (301) 762-7338 · Fax: (301) 424-4399 · Send us an email!
	Affiliated with The United Synagogue of Conservative Judaism, which hosts this website as one of the many services provided to member congregations.