SHANNA BEIS APPLICATION FORM
Fill out the form carefully for registration
Student Name
First Name
Middle Name
Last Name
Date of Birth
Month/Day/Year
Jewish Birthday
Month/Day/Year
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Email
Mobile Number
-
Area Code
Phone Number
Phone Number
-
Area Code
Phone Number
High School I attended
Seminary I have learned in
I would like to commit to the following Merkos shiurim
Please note we have the following classes daily. Monday to Friday with Rabbi Hoch Tanya at 9am Sichos at 10am and Daily Halacha at 11.30am. Every afternoon we have Chitas at 1.30pm. All classes run for an hour. Our evening schedule runs every evening between 7pm and 9pm.
Home stay and a half day of learning
Evening program and stay at home
Full dorm program with learning
Additional comments
References
Please include the name and number of at least two references
Rabbi/Teacher:
Friend:
Medical
Name of Dr
Address of Dr
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have any medical conditions that the seminary should be aware of?
Please answer in less than 100 words why you would like to be part of a Shanna Beis Program:
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