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College Connection -Keri Brooke Heiken College Outreach Registration Form
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Do you have a college-age student (about to graduate high school, in undergraduate studies, gap year, Israeli Army, graduate studies, or other program)? We would love to include your family in our newly revamped Beth Torah College Outreach Program. This amazing program strives to maintain positive connections with Beth Torah, our clergy and your incredible student while they grow and evolve during their post high school years.
This exciting program includes special outreach opportunities like care packages, occasional zooms and messages from the Rabbis and Cantor, and other optional fun networking opportunities to connect our young adults to each other and to Beth Torah, while they are away from home.
Please complete the information below so your student can be included. Complete one form per student.
*
Student/Recent Graduate's Name
Student's Birthday
*
Name of College/University Attending (or NA)
Program Type
Undergraduate Studies
Graduate Studies
Gap Year
Other
*
Year of Graduation
*
Student's Fall Address (for package delivery)
*
Student's Fall Address 2
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
*
Mobile Number of Student/Recent Graduate
*
Email Address of Student/Recent Graduate
Student's Relationship to you.
Child
Grandchild
Self
Other
I would like to join the Beth Torah College Outreach Committee. (Check here)
I would like to join the Beth Torah College Outreach Committee. (Check here)
Parent's Email
Any additional information we should know
Any additional information we should know
Thank you for your prompt reply and help in this exciting program.
If you do not know your studen's contact address at the time you are completing this form, or if your student's contact information changes, please notify the Beth Torah offices and/or complete a new College Connection form so that we may continue to reach them.
For each additional student, please submit this form and complete another form.
Mon, April 29 2024
21 Nisan 5784
Mon, April 29 2024 21 Nisan 5784