Kol Yisrael

First and Last Name *

Preferred Pronouns *

Birthdate * +

Email *

Cell *

Anticipated Grad Year *

Home Address - Street, City, State, Zip *

Parent / Guardian Name *

Parent / Guardian Email *

Parent / Guardian Cell *

We'd love to get to know you a bit better! Please tell us your Jewish story. *

Have you participated in Birthright Israel? *

Yes

Not yet!

I'm not eligible

How did you hear about this class? *

Hillel Staff

Email, Website, or Brochure

Another Student

Other Other

Which, if any of these, have you participated in previously? Check any that apply. Please know there are no wrong answers - we are just getting to know you! *

Would you be interested in receiving emails about future Jewish opportunities for young adults from Hillel's funders? *

Yes

No