* 1. Your Name:

2. Gender

* 3. Your Email:

* 4. Contact Number:

5. College or University you attend:

6. When is your expected graduation date?

7. Are you a member of a student group that addresses the Palestinian-Israeli issue?

8. How many students are currently part of your group?

9. What types of activities, events, or campaigns does your group support? (check all that apply)

10. Is your group currently running a BDS Campaign?

11. If yes, what companies are you targeting?