APPLICATION FOR ADMISSION

APPLICATION FOR ADMISSION

7045 N 12th Street., Phoenix , Arizona 85020 602-266-1213 1 800 660-0335(fax)
I. APPLICANT INFORMATION
Application for which grade for the upcoming Academic Year?*
Applicant’s English Name:*

First NameLast Name
Applicant’s Hebrew Name:*
Will you require dormitory arrangements?*

YESNO
Date of Birth*

MonthDayYear
Date
Hebrew Date of Birth:*
Social Security Number:*
Current School:*
II. FATHER’S INFORMATION
Father’s Name*

First NameLast Name
Father’s Hebrew Name:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Phone Number*
Please enter a valid phone number.
Home Number*
Please enter a valid phone number.
Cell Number*
Please enter a valid phone number.
Email*
example@example.com
Father's Occupation*
Place of Employment*
III. MOTHER’S INFORMATION
Mother's Name*

First NameLast Name
Mother's Hebrew Name*
Mother's Address (If different than above)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Home Phone Number*
Please enter a valid phone number.
Cell Number*
Please enter a valid phone number.
Work Number*
Please enter a valid phone number.
Email*
example@example.com
Mother's Occupation*
Place of Employment*
Please List Siblings Of Applicant And Birth Dates:*
IV. OTHER INFORMATION
Synagogue affiliation, If any:*
With which Jewish organizations and congregations are your family affiliated? (Up to 3)Name of leader or presiding officer and Location*
If parents are separated, divorced or if either parent is deceased, please indicate if divorced or separated, whom the applicant lives with:*
(If parents are legally separated or divorced, please enclose copies of custodial documentation.)
Are there any conversions in the family? If yes, please provide details.*
Is the applicant adopted? If yes, please provide details.*
Maternal grandparents’ names and address:*
V. Please Complete – This information is confidential.
Does applicant have any current health problems or particular disabilities? (If yes, please specify)*
Does applicant have any learning issues, (i.e. ADD or ADHD) or any condition that needs special accommodations? Has the applicant ever had an IEP or been enrolled in a special education program? Also, has the applicant ever been retained? If so, what grade?*
Is the applicant taking any medications? If so, indicate name and dosage:*
Has applicant ever seen a therapist or educational evaluator? If so, written reports must be included. List Name and contact information of therapist:*
Has applicant had any significant discipline issues? Please explain:*
Is the applicant current on all Immunizations?*
Has applicant ever been asked to leave a school or not return for the new school year? If yes, please explain:*
VI. Current School
Name and Location of Current School*
Current Principal*
Principal's Phone number*
Please enter a valid phone number.
Name of presentJudaic studies teacher:*
Judaic Teacher's Phone Number*
Please enter a valid phone number.
Describe the extent of the applicant’s Hebrew Education?*
Please List In Chronological Order All Previous Schools Applicant Has Attended:Include the Name of School & years attended with a complete Address, Phone & fax numbers. Include the names of the Dean and/or Principal*
It is mandatory for you to provide transcripts (8th grade and above) from all schools with your application. Yeshiva High School of Arizona will not accept any students without transcripts.
Describe the Judaic Studies courses the applicant is taking this year:*
Describe the General Studies courses the applicant is taking this year:(Please be specific: i.e: Geometry rather than just Math)*
Describe any prizes or awards that the applicant has received:*
Remittance of an application fee of $50 is non-refundable.

A paper Application can be downloaded at www.azyeshiva.org/register and should be sent to:
Yeshiva High School of Arizona ~ 7045 N. 12th Street. ~ Phoenix, AZ 85020

or by email office@azyeshiva.org
All applicants must:

1) Enclose copy of birth certificate with application

2) Enclose completed medical forms and emergency contact information with enrollment contract, especially a clear front & back copy of insurance card

3) Interview with Rabbi Goetz and our General Studies Principal

4) Send all transcripts, standardized test results and report cards for 8th grade and up from all previous schools prior to the interview.

5) Take a written entrance exam and/or subject placement tests
Date

MonthDayYear
Date
Full Name of Parent or Guardian
Parent or Guardian's Signature*

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Yeshiva High School of Arizona is committed to inspiring our students with
enthusiasm for Torah life. Our dual curriculum is designed to develop our
students' potential, providing proficiency in both Torah studies and general
knowledge through our excellent General Studies program. By emphasizing the
development of exemplary character and sensitivity to others, our graduates
will gain skills vital to creating successful relationships in all areas of life. Our
nurturing environment provides students with a strong sense of self-confidence,
enabling them to become leaders of the next generation.
NOTICE OF NONDISCRIMINATORY POLICY AS TO STUDENTS
Yeshiva High School of Arizona admits Jewish students of any race, coIor, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school
administered program.
Should be Empty:

APPLICATION FOR ADMISSION

I. APPLICANT INFORMATION

II. FATHER’S INFORMATION

III. MOTHER’S INFORMATION

IV. OTHER INFORMATION

V. Please Complete – This information is confidential.

VI. Current School