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Tuition Payment Form

Please complete the form below. Required fields marked with an asterisk *

Note: If you choose to pay your tuition balance by credit card, you will be responsible for any associated transaction fees. To avoid these fees, you may mail a check made out to SEGULA to the Jewish Education Center.

CONTACT INFORMATION

First Name*

Answer required for "First Name"

Middle Initial

Answer required for "Middle Initial"

Last Name*

Answer required for "Last Name"

Student's Name:*

Answer required for "Student's Name:"

School*

Answer required for "School"

ADDRESS

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Email Address*

Answer required for "Email Address"

Phone Number*

Answer required for "Phone Number"

Amount*

Answer required for "Amount"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"