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Koach Signup Form

 

 

 

PARENTS!!!

Did you know that KOACH is the official program of the United Synagogue of Conservative Judaism for college age students? Did you know that your student doesn't have to do anything? S/he is automatically a member. Just complete the information below and press "Submit" to send the information to Suzi Arencibia, Koach Advisor, and help your student keep informed and be involved.

If you prefer to print the form, you can return it to the synagogue office (ATTN: KOACH.)

Please register me (or my student) for the KOACH Program. (There is more information at the national KOACH web site.)

NAME:              

BIRTHDATE:      

CELL PHONE #:  

HOME E-MAIL:   

HOME ADDRESS:

SCHOOL NAME: 

YEAR:   Freshman    Sophomore      Junior      Senior      Other

ANTICIPATED YEAR OF GRADUATION:

COLLEGE ADDRESS:
                      

COLLEGE PHONE #:
                      

COLLEGE E-MAIL:

IS THERE A HILLEL ON CAMPUS?   Yes    No

COMMENTS (up to 120 characters:
                     

PARENT'S E-MAIL (not required):