UM Hillel Registration Form
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Name:
First
Middle
Last
UM Affiliation
(check all that apply):		 Faculty/Staff
Friend of UM Hillel
Parent
Student
Washtenaw Jewish Community
Address:
Street Address:


City:
State:
Zip:
Country:
Phone:
Email:
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University of Michigan Alumni Yes No

If you have more than one degree, refer to the most recent.
Name at Graduation:
First
Middle
Last
Class Year Degree
School/College

Child 1 Name:Class Year:
Child 2 Name:Class Year:
Child 3 Name:Class Year:
Child 4 Name:Class Year:

Student Status
Parents' Names:
Parents' Address:
City:
State:
Zip:
Phone:
Mother's email:
Father's email:
Student ID:
Proposed Graduation Year Degree
School/College
Are you married? Yes No
Spouse Name:
First
Middle
Last
Is your spouse an alumni? Yes No
Your Spouse's UM Affiliation (check all that apply) Faculty/Staff
Friend of UM Hillel
Student Washtenaw Jewish Community

If your spouse has more than one degree, refer to the most recent.
Name at Graduation:
First
Middle
Last
Class Year Degree
School/College
Proposed Graduation Year Degree
School/College

Would you like to receive our newsletter? Yes


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