Hillel at Virginia Tech · New Student Information Form

Basic Information

Name *

First Name

Last Name

Pronouns *

Email *

Verify Email *

Phone Number *

Home Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

School Information

Graduation Year *

University Attending *

Fraternity/Sorority (if applicable)

Residence Hall

School Of *

Major

Home Information

Parent/Guardian 1 Name *

First Name

Last Name

Parent/Guardian 1 Email *

Verify Email *

Parent/Guardian 1 Phone # *

Is Parent/Guardian 1's address the same as your home address? *

Yes

No

Parent/Guardian 1 Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Are they a VT alum? *

Yes

No

Parent/Guardian 2 Name

First Name

Last Name

Parent/Guardian 2 Email

Verify Email

Parent/Guardian 2 Phone #

Is their address the same as parent/guardian 1?

Yes

No

Parent/Guardian 2 Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Do you/your family belong to a synagogue in your hometown? *

Yes

No

Name of congregation & city *

Did you attend a Jewish Summer Camp? *

Yes

No

Name of summer camp *

How do you identify Jewishly? *

Reform

Conservative

Orthodox

Reconstructionist

Renewal

Just Jewish

Exploring Judaism

Not Jewish

Other

If you selected other, please describe: *

Getting Connected!

Let us know what you are interested in so we can connect you to all of our amazing programming!

Other Interests

Travel to Israel - Birthright, Perspectives, Onward

Immersive Service Experiences - Alternative Spring Break

Professional Development

Leadership

Shabbat Experiences

Are there other things you are interested in? Let us know below!