College Student Gifts - 2018/19 - Form

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College Student Gifts - 2018/19

Please fill out the information below and we will gladly send your college student gift packages from Stephen Wise Temple throughout this academic year!
NOTE: For more than one student, fill out separate forms.

* YOUR First Name

* YOUR Last Name

* YOUR Email Address

* YOUR Phone Number

NOTE: We request your phone number ONLY for verification purposes or if we have trouble contacting you by email.

* Student's First Name

* Student's Last Name

Student's Email Address

* Student's College/University Name

Aniticipated year of graduation

* Address (Line 1)

Address (Line 2)

* City

* Zip Code

Would you like to help us package and mail gifts on Friday, October 5?

Please select:YesNo

Wed, June 26 2019 23 Sivan 5779

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change the world.

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15500 Stephen S. Wise Dr.

Los Angeles, CA 90077

Phone: 310-476-8561

Email: LetsConnect@WiseLA.org

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