Student Interest Form

First Name: *
Last Name: *
E-mail Address: *
Major/Program/Department:
Fraternity or Sorority (if applicable):
Year in school:
Graduation Date:
Graduation Year:
School Address
Street Address:
City:
State:
Zip:
Phone:
Home Address
Street Address:
City:
State:
Zip:
Phone:
Parent(s') Name(s)

I am interested in: (Check all that apply)

Please verify you're a human:

USC Hillel | 3300 S. Hoover Street, Los Angeles, CA 90007 | NE Corner of Hoover and Jefferson
Tel: 213-747-9135 | Fax: 213-742-8824 | www.USCHillel.org | info@uschillel.org
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