B Next Stay Connected Form
Please take a moment to fill out the form below. This information will be used to stay connected with our college students. We know that it can be difficult being a college student in general with all the stressful test, quizzes, and projects. We want to do something special just for you by sending a gift from time to time. This gift will include variety of things that will help you get through this semester! 
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Full Name of College Student *
Phone Number *
Birthday *
MM
/
DD
/
YYYY
Name of the College/University You Attend? *
Graduation Year *
College Address or P.O. Box *
Preferred Grocery Store Gift Card *
Favorite Snacks/Candy *
Favorite Restaurants *
Please provide any extra information about yourself. (Examples: Hobbies, favorite color, favorite sports team, and etc). 
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