College Connection

Parent's Name*

First Last

Parent's Phone Number*

Parent's E-mail*

Number of Students*

For more than 2 students please fill out multiple forms.

Student's Name*

First Last

College*

Complete Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

E-mail*

Date of Birth*

Choose One*

Please specify any food allergies:*

Student's Name*

First Last

College*

Complete Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

E-mail*

Date of Birth*

Choose One*

Please specify any food allergies:*

The cost of the College Connection program, including postage, has increased steadily over the years. While payment is not required for participation, we greatly appreciate donations to help us cover our costs. We suggest a minimum donation of $54 for each student from an RTFH member family. For each student from a non-member family, a $72 donation is required.

Payment Amount:

For no donation, please type $0.

Total

Pay By

Credit Card

Check

Credit Card

Card Details

Cardholder Name

If paying by check, make it out to RTFH Women's Connection. Please send checks to RTFH, 71-11 112th Street, Forest Hills, NY 11375, Attn: Women's Connection.