Birthright Interview Information Form - Berkeley Hillel : Berkeley Hillel

Student Information

Name*

First Last

SID*

Berkeley Email*

Non-Berkeley Email*

Phone Number*

Year of Graduation*

Major

I'm looking for...*

Dietary Restrictions*

Please let us know any dietary restrictions you have so we may provide food and snacks.

Is there anyone else you know who might be interested in going on Birthright with Berkeley Hillel that we should reach out to?

First Last

Email

Parent/Guardian 1 Name*

First Last

Parent/Guardian 1 Preferred Email*

Parent/Guardian 1 Phone*

Permanent or Parent/Guardian 1 Home address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian 2 Name

First Last

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

My 2nd Parent/Guardian has...

Parent/Guardian 2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country