This initial form is to allow your student organization to officially affiliate with the Schusterman Hillel International Center through the Soref Initiative for Emerging Hillel Campuses. In order to complete this form you MUST first be a recognized student organization on your University’s campus.* indicates a required field

University Information

University Name: *

University Address: *

University Address Line 2:

City: *

State or Province Abbreviation: *

Zip / Postal Code: *

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Hillel Information

Hillel Name: *

Hillel Mailing Address: *

Hillel Mailing Address Line 2:

City: *

State or Province Abbreviation: *

Zip / Postal Code: *

Hillel Office Phone Number: *

Hillel Office FAX Number: *

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Advisor Information

Advisor's Name: *

Advisor's Email: *

Advisor's Phone Number: *

Advisor's Start Date: *

Paid Advisor
Volunteer Advisor* If the Advisor is paid, how many Hours / Week do they work?

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Student Board Information

Student Board Information: please include names, positions, phone numbers, and e-mail addresses for all members of your student board. All Hillel Student Organizations MUST have a student board.* Only one full student entry is required.

Name:	Position:	Phone Number:	E-mail Address:

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Your Information

First Name: *
Last Name: *
Email Address: *