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Student Referral Form 

Do you have a friend or relative who will be attending university? Help them join a vibrant, welcoming Jewish community on campus: Connect them to their local Chabad student center. Just complete this short form; we'll take care of the rest.

Your Info:

Name:  Email:

Student #1 Info:

Name:   Year:

University :
(Other:  )

Telephone:  Email:   

Student #2 Info (if applicable):

Name:   Year:

University :
(Other:  )

Telephone:  Email:   

Comments:

 

Please submit this form again for additional referrals.

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