Congregation B'nai Tikvah
College Connection

For legibility, please fill in the form on screen then print it.

Student Name:  
School Name:  
Mailing  
Address:		 
City:     State   Zip
  I expect to be at the same address next semester Yes   Not sure
 

 

  College Phone   Cell Phone
E-mail:  
Major/Minor:  
  Freshman   Sophomore   Junior   Senior   Graduate
 
Parent's
Names: 		 
Address:  
City/State/Zip:        Phone 
E-mail  
    I'd like to be on the College Connection Committee.

 

  I give permission to share my child's e-mail address and/or mailing address with KOACH, Hillel, Honest Reporting Campus, and CAMERA for their free college newsletters and subscriptions.

 

  Enclosed is my voluntary activity fee of $18 ($36 for two or more children) to help us defray the cost of our mailings throughout the year.

Congregation B'nai Tikvah
1001 Finnegans Lane
North Brunswick, NJ 08902
Send email Bonnie Eisenberg, 732-355-0887