Application for Admission

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- Step 1 of 10

Application Date *

School year *

GRADE ENTERING *

Why? PHONE communal,

STUDENT LAST NAME

FIRST NAME/LEGAL

MIDDLE NAME/LEGAL

HEBREW NAME/NAME USED

DATE OF BIRTH

Address

Address Line 1

Address Line 2

City

State

Zip Code

HOME PHONE NUMBER

STUDENT CELL PHONE NUMBER

STUDENT EMAIL ADDRESS

PLACE OF BIRTH - CITY, STATE, COUNTRY

AGE

SOCIAL SECURITY

PARENT INFORMATION

FATHER’S NAME

OCCUPATION

BUSINESS PHONE

FATHER’S CELL PHONE NUMBER

FATHER’S EMAIL ADDRESS

MOTHER’S NAME

OCCUPATION

BUSINESS PHONE

MOTHER'S CELL PHONE NUMBER

MOTHER’S EMAIL ADDRESS

PARENT’S MARITAL STATUS:

PARENT’S ADDRESS & PHONE NUMBER (IF DIFFERENT FROM ABOVE)

FATHER OR MOTHER

Phone

PATERNAL GRANDPARENTS

Address

Address Line 1

Address Line 2

City

State

Zip Code

HOME PHONE NUMBER

MATERNAL GRANDPARENTS

Address

Address Line 1

Address Line 2

City

State

Zip Code

HOME PHONE NUMBER

SIBLINGS

To add more siblings click on the plus + button on the right side of each line.

NAME OF SIBLING

AGE

WHICH SCHOOL ATTENDING/PRESENT OCCUPATION

NAME OF SIBLING

AGE

WHICH SCHOOL ATTENDING/PRESENT OCCUPATION

ADDITIONAL SIBLINGS

Use the +Add button to add more siblings

NAME OF SIBLING

AGE

WHICH SCHOOL ATTENDING/PRESENT OCCUPATION

LIST SCHOOL YOU ARE CURRENTLY ATTENDING

PRESENT SCHOOL ATTENDING

PRESENT GRADE IN HEBREW/SECULAR

PRINCIPAL

NAME OF YOUR CURRENT REBBE

PHONE NUMBER

WHO REFERRED YOU TO OUR YESHIVA - NAME

RELATIONSHIP TO STUDENT

CELL PHONE NUMBER

LIST SCHOOLS YOU HAVE PREVIOUSLY ATTENDED, THE MOST RECENT ONE FIRST

Previous Schools:

NAME OF SCHOOL

GRADE(S) ATTENDED

MONTH/YEAR STARTED

MONTH/YEAR FINISHED

STUDENT QUESTIONNAIRE (To be filled out by the student)

1. What is your favorite Limudei Kodesh subject?

Why?

2. What is your favorite Secular Studies subject?

Why?

3. What is your least favorite Limudei Kodesh subject?

Why?

4. What is your least favorite Secular Studies subject?

Why?

5. List your interests and hobbies:

6. How have you spent your last two summers?

7. How do you feel you can contribute to the yeshiva? What are some of your personal strengths?

8. In which areas would you like to grow?

9. List any scholastic and extra curricular achievements/courses you have participated in:

PARENT QUESTIONNAIRE (To be filled out by parent)

1. Please share with us some of your sons' strengths and personal character traits that you would like us to know about.

2. What are your expectations for your child’s high school experience?

3. Does your child have any special medical situation (past or present) that we should be aware of? Please list any allergies.

4. Has your child had any educational testing or counseling (Academic, Social, Etc.)?

5. Does your child have an IEP?

Does your child receive any type of services?

6. Is there any additional information you would like to share with us concerning your child or family situation?

7. Indicate your affiliation with with any communal, religious or educational organization? (Which shul do you attend? Who is your Rav?)

REFERENCES LIST TWO REFERENCES, PREFERABLY, INCLUDE YOUR RABBI AND A SCHOOL TEACHER OR PRINCIPAL

NAME

First

Last

PHONE NUMBER

RELATIONSHIP

NAME

First

Last

PHONE NUMBER

RELATIONSHIP

It is understood that the registration of all students admitted to the Yeshiva is subject to the following conditions: Attendance at the Yeshiva is a privilege and not a right. The Yeshiva reserves the right to demand the withdrawal of any student at any time, for any reason, which it deems sufficient. Continuing enrollment in the Yeshiva is dependent upon the maintenance of regular and satisfactory work, both in the Limudei Kodesh and Secular Departments. The student and family are required to familiarize themselves with, and to abide by, all the regulations of the Yeshiva.

We hereby certify that the information given in this Application is complete and accurate.

We have read and understood the Family/Student Handbook of the school. We agree to all the terms therein.

Signature of Applicant:

Clear Signature

Date

Signature of Father:

Clear Signature

Date

Signature of Mother:

Clear Signature

Date

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