» Student Board
» FYSH Retreat Fall 2008
» Student Groups
» Tzedek Means Justice
» JLI - Jewish Learning Initiative
» GAP
» Jobs & Internships at Hillel
» Campus Resources
» The Center For Jewish Studies
» UCLA Israel Studies Program
» Prospective Students
» Student Information Form
» Alternative Spring Break
Home
Our Building
Sign Up for eNewsletter
Photo Gallery
eStore
Contact Us

  
 
Home > Student Life > Prospective Students > Prospective Student Hospitality Request
Prospective Student Hospitality Request
* required information
 
Contact Information
First Name:*
Middle Initial:
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Cell Phone:
Undergraduate Graduation Year:*
Birth Date:(mm/dd/yyyy)
Gender:* Female   Male  
Parent 1 First Name:*
Parent 1 Last Name:*
Parent 1Type:* Mother
Father
Parent 1 Address 1:*
Parent 1 City:*
Parent 1 State:*
Parent 1 Zip:*
Parent 1 Home Phone:*
Parent 2 First Name:
Parent 2 Last Name:
Parent 2 Type: Mother
Father
Parent 2 Address 1:
Parent 2 City:
Parent 2 State:
Parent 2 Zip:
Parent 2 Home Phone:

Visit Information
Date of Visit:*(mm/dd/yyyy)
Arriving:*
Departing:*
Which Shabbat service would you most likely attend?:*
Would you prefer to stay with a student who observes Shabbat?:* Yes
No
No preference
Do you keep kosher?:* Yes
No
Do you have any allergies?:* Yes
No
If yes, please explain:
        
About Hillel|Student Life|Events|Shabbat/Holidays|Israel|Dining|Parents/Alumni|Resources|Donate Now

Our Kintera web-site has been made possible by a generous donation from Caryn & Alan Viterbi.
©2005 Hillel: The Foundation for Jewish Campus Life                              LIVE.LOVE.LEARN...EAT!