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Your Contact Informaiton
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Email*
Alternate Email
Anticipated College Graduation Year*

Parent Information
Parent (1) Name
First Last
Parent (1) Email
Parent (2) Name
First Last
Parent (2) Email

Additional Information About You
I am in Freshmen Connection
- Yes
- No
I am interested in:
- Community Service/Social Justice
- Alternative Breaks
- Birthright Israel (Free Trip to Israel)
- Israel
- Jewish Learning
- Shabbat
- I want to get involved but I'm not sure where...
- Other
Select all that apply
Please describe:
I consider myself to be:
- Orthodox
- Reform
- Conservative
- Reconstructionist
- Just Jewish
- Not Jewish
- Other
I spent a year in Israel
- Yes
- No
If yes, Name of Program
I was in a Jewish Youth Group
- Yes
- No
If yes, please choose all that apply
- USY
- NFTY
- BBYO
- NCSY
- Young Judea
- Other
Please specify:
I went to Jewish Summer Camp
- Yes
- No
If yes, name of camp:
I am involved in Greek life at UMD
- Yes
- No
Which Greek House are you in?
- Alpha Chi Omega
- Alpha Delta Pi
- Alpha Delta Phi
- Alpha Epsilon Pi
- Alpha Epsilon Phi
- Alpha Omicron Pi
- Alpha Phi
- Alpha Xi Delta
- Alpha Sigma Phi
- Alpha Tau Omega
- Beta Theta Pi
- Chi Phi
- Delta Chi
- Delta Delta Delta
- Delta Gamma
- Delta Phi Epsilon
- Delta Sigma Phi
- Kappa Alpha Order
- Kappa Alpha Theta
- Kappa Delta
- Kappa Delta Phi
- Kappa Sigma
- Lambda Chi Alpha
- Phi Delta Theta
- Phi Gamma Delta (Fiji)
- Phi Kappa Psi
- Phi Kappa Tau
- Phi Sigma Sigma
- Sigma Chi
- Sigma Delta Tau
- Sigma Gamma Rho
- Sigma Kappa
- Sigma Nu
- Sigma Phi Epsilon
- Tau Kappa Epsilon
- TEP
- Theta Chi
- Zeta Beta Tau
- Zeta Psi
- Zeta Tau Alpha
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