Please fill out this form to receive your very own Mezuzah for your room.
Please note: only one freeMezuzah is available per student.

Student Info

Name*

First Name Last Name

Phone*

Area Code Phone Number

E-mail*

Parents Address*

Birthdate*

Month Day Year

Graduation Year*

Major/Degree:*

I am a:*

UF StudentUF Grad StudentSFC StudentUF Alumnus

Are you Jewish?* Check all that apply

Fraternity/Sorority:*

Parents Info:

Father’s Name*

First Name Last Name

Father’s E-mail*

Father’s Phone*

Area Code Phone Number

Mother’s Name*

First Name Last Name

Mother’s Phone *

Area Code Phone Number

Mother’s E-mail*

Ideal date/day/time to have my Mezuzah affixed (list a few options):

I live at select one:

DormApartment ComplexHouseFraternity/Sorority

Your Gainesville Address Please include: Name of dorm or apartment complex, apt # etc.

Comments or questions:

Mezuzah is being offered free of charge. Donations are encouraged and greatly appreciated to help cover the costs.

Donation Amount

Payment

Credit Card Paypal Check/Venmo/CashApp/Zelle

Postal / Zip Code

Country

Please mail your check to: Lubavitch Chabad Jewish Center, 2021 NW 5th Ave. Gainesville, FL 32603