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Online Application

Online Application

Online Application

Student's Information
Date of Application:
Grade Entering:
First Name:
Last Name:
Hebrew Name:
Address:
City, State, Zip, Country
Home Phone:
Student Email:
Hebrew Date of Birth:
English Date of Birth:
How you heard about Bais Chaya:
Social Security Number:

Is the applicant adopted?

Yes No

Were both parents born into the Jewish Faith? Yes No
Were all grandparents born into the Jewish Faith? Yes No
Physical handicaps? Yes No
If yes, explain:
Any serious illnesses? Yes No
If yes, explain:
Is the applicant currently on any medications? Yes No
If yes, explain:
Does the applicant have any special learning needs? Yes No
If yes, explain:
Has your daughter ever experienced any of the following problems?


ADDITIONAL FAMILY INFORMATION:

Father's Information
Name:
Hebrew Name:
Home Address
(if different from student)
Cell:
Email:
Occupation:
Job Title:
Employer
Business Name:
Business Address:
Business Phone:
Mother's Information
Name:
Hebrew Name:
Home Address
(if different from student)
Cell:
Email:
Occupation:
Job Title:
Employer:
Business Name:
Business Address:
Business Phone:
Please indicate name(s) of person(s) and address(es) who should receive report cards if different from above:
Are Parents Married? Yes No
Separated? Yes No
Divorced? Yes No
If yes, who has legal custody?
With whom does the student live?


BACKGROUND EDUCATION INFORMATION

List names and dates of schools attended from preschool to present including Talmud Torah attendance:

School Name Location Dates of Attendance

Has the student ever been dismissed from any schools? Yes No
In yes, explain:
Indicate briefly the extent of the student's education by subject studied: (indicated the language in which they were studied: Hebrew, English, Yiddish).
Favorite subject:
Most difficult subject:
List scholarships, prizes, contests or other awards:
List extra-curricular activities:
List organization memberships:

Essay - Please email a 500 word essay to admin@rohrbaischaya.com.

Topic: Tell us about a personal character trait that you've worked on developing. Explain why you chose to focus on this particular thing, how you went about it, and what you feel the results have been. Make sure to use real examples to strengthen your points. How do you see yourself continuing to grow in this area?

Questions or Comments?

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