Falon's Chicken Soup Hotline - Penn State Hillel : Penn State Hillel

Student Information

Student's Name*

First Last

Student's Address (Include Dorm or Apt Number)*

Street Address Address Line 2 City State ZIP Code

Student's Phone #*

Student's email*

Student's Expected Graduation Year*

Is the sick student experiencing flu or strep throat symptoms?*

Yes
No

Is the sick student experiencing COVID-19 symptoms or has tested positive for COVID-19 in the past 10 days?*

Yes
No

Would the person like chicken soup or vegetarian soup?*

Chicken
Vegetarian
Gluten Free

Does the person keep Kosher?*

Yes
No

When will this student be in their room to receive the soup?*

Select All
5:00-5:30
5:30-6:00
6:00-6:30
6:30-7:00
7:00-7:30
7:30-8:00

Please help us build our delivery schedule by selecting all times that the student will be in their room

Requesters Information

I am requesting for myself.

Same as above

Your Email Address*

Your Name*

First Last

Your Phone #*

Relationship to sick student:*

Parent
Relative
Roommate

This field is hidden when viewing the form

Your Relationship to Sick Student

How does the student identify Jewishly?*

Please check all that apply

Other

How did you hear about the Chicken Soup Hotline?

Additional Information

Would you like to make a gift to help keep this program alive?

$50
$36
$18
Other

Gifts are welcomed, but not required to order soup.

Enter Other Amount

Total

$0.00

Address*

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

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Falon’s Chicken Soup Hotline

Chicken Soup Hotline

Student Information

Requesters Information

Other