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?*

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

Would the person like chicken soup or vegetarian soup?*

Does the person keep Kosher?*

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

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

Your Email Address*

Your Name*

First Last

Your Phone #*

Your Relationship to Sick Student*

How does the student identify Jewishly?*

Please check all that apply

How did you hear about the Chicken Soup Hotline?

Additional Information

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

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