Subsidized Mezuzah Request
(Subject to availability)
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Class Of
*
Please Select
2026
2027
2028
2029
2030
Gard
Expected graduation year
I live
*
Off Campus
On Campus
I'd like to pay
*
$18/mezuzah (we'll cover the other $82)
$60/mezuzah (we'll cover the other $40)
I can't afford to pay anything right now
Interest/Survey Question
*
I'm Jewish
I'm not Jewish, but interested in this.
Which parent is Jewish?
*
Father
Mother
Both
Neither
I commit to taking the mezuzah with me when I move out, and either returning it to Chabad for a full refund or using it in my next home.
*
Other comment/s
Submit
Should be Empty: