COLLEGE INFORMATION REQUEST

We are Central Synagogue are committed to maintaining contact with our young people throughout their years at college. This is a critical time in their lives, and we want them to ahve this link and know that we're still here fror them. Throghout the year, we sendh oliday packages and information to keep them connected. But we wan't do that if we don't know their addresses! Please fil out the form below and send it back to the temple as soon as you know the information. Thank you.

STUDENT __________________________________________________ BIRTHDATE _______________________

COLLEGE __________________________________________________________ YEAR _____________________

ADDRESS _________________________________________________________________________________________

_________________________________________________________________________________________

CITY __________________________________ STATE _________________ ZIP __________________

EMAIL ADDRESS ____________________________ PARENTS' NAMES ___________________________________