STAR-K 23rd Annual Kashrus Training Program Application Form

23rd Annual Kashrus Training Program Application
Name*

TitleFirstLast
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone*
Format: (000) 000-0000.
Email Address*
Age*
How did you find out about this program?*
I am currently employed by
Employment position
I am currently in the following Kollel
Reference 1 (Name, Title, Phone)*
Reference 2 (Name, Title, Phone)*
Why are you interested in this program?*
Do you have Semicha?*

YesNo
Where do you have Smicha from?*
Are you studying for Smicha?*

YesNo
If you have any comments, please write them here:
There is a $75 charge for the course. The fee must be submitted with the application. This will be returned if the applicant is not accepted. Applicants who are accepted but do not complete the course will forfeit their deposit.

Kashrus Training Program

$75.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country