Prospective Student Info Form - North Carolina Hillel

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Prospective Student Info Form
Contact Information
First Name:*
Last Name:*
School:
Campus Address Line 1:
Campus Address Line 2:
Campus City:*
Campus ZIP:*
Home Address:*
Home City:*
Home State:*
Home Zip/Postal Code:*
Parents' Names:
Email:*
Phone:
Major:
College Graduation Year:*
Birth Date:	(mm/dd/yyyy)
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Additional Information
What are some of your interests, hobbies, and activities outside of school?:
Are any of your family members also students or alumni of North Carolina schools?:	Yes No
If so, please list the name, school, graduation year, and relationship to you.:

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