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  ___________________________________