Online Admissions Application

Education

Section to be completed by the Parent
Name of Principal
Phone Number
Name of Rebbi
Phone Number
Name of Shul Rav
Phone Number
Medical History

Section to be completed by the Parent
Medications & Allergies
Are there any issues (medical, emotional, learning etc.) that we should be aware of?
I agree to show proof of my child's up-to-date vaccinations and verify that he has received all required doses of vaccines on the CDC recommended schedule.
Signature

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Date

MonthDayYear

Tuition

Section to be completed by the Parent
Annual tuition is $17,000.00

I agree to pay the full tuition rateI will request a reduced tuition rate
Signature

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Date

MonthDayYear
*** Application must include a $50.00 application fee, payable to YGSB ***

Applicant Section

Section to be completed by the Applicant
Please list other school(s) attended:
Name of School
Year(s)
Name of School
Year(s)
Please list camp(s) attended:
Name of School
Year(s)
Name of School
Year(s)
What are the main reasons for your interest in our Yeshiva?
What are you favorite subjects – in both kodesh and secular studies?
Please list notable achievements and awards in both kodesh and secular studies.
Have you ever been expelled or suspended? If yes, please elaborate.
Enrollment in Yeshiva Gedola of South Bend requires that you keep its rules, maintain regular attendance and display good work ethic in all subjects.

YGSB admits students of any race, color, national or ethnic origin to all the rights, privileges, programs and activities general-ly accorded or made available to students at the school. It does not discriminate on the basis of race, color, national or ethnic origin in the administration of its educational policies, admissions policies, scholarship and loan programs, athletic and other school administered policies.
Signature of Applicant

Clear
Date

MonthDayYear
Should be Empty:

Parent's Information