2023-2024 Admissions Application

1. Please answer all questions. All information is strictly confidential. If a question is not applicable, kindly enter N/A.

2. A non-refundable application fee of $175.00 must accompany this application.

3. The Applicant's Evaluation Form must be completed by both the Limudei Kodesh and General Studies Principals of your son's current school. Your Principals should mail their completed forms, accompanied by Limudei Kodesh and General Studies transcripts, directly to Mesivta Ateres Yaakov. (The Principals' Evaluation Form is available to print on this application)

4. The applicant will be required to take an oral examination in Judaic Studies and appear for a personal interview.

5. Upon receipt of completed application and evaluation forms, the applicant will be contacted to schedule an interview.

Please be advised: An interview cannot be scheduled until the Principals' Evaluation and school transcripts have been received by the Mesivta office.

Applicant's Name*

First NameLast Name

Grade 9

Name applicant goes by (if different from above):

How applicant is called up for an Aliyah*

Name (ben) Father's Name - Kohen/Levi

Date of Birth*

MonthDayYear

Place of Birth (if foreign, indicate year of US arrival)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number*

Area CodePhone Number

Applicant's Cell Number (if the applicant does not have a cell phone please leave blank)

Area CodePhone Number

Applicant's Email (if the applicant does not have an email, please leave blank)

example@example.com

Name of Current School*

Name of current Rebbi*

Phone Number of current Rebbi

Area CodePhone Number

Home School District*

Father's Full Name*

First NameLast Name

RabbiDr.Mr.Other

Father's Address (if different from applicant's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Father's Home Phone (if different from applicant's)

Area CodePhone Number

Father's Cell Number*

Area CodePhone Number

Father's Email*

example@example.com

Father's High School

Father's Post High School Yeshiva(s)

Father's Shul(s) attended

Father's Undergraduate School & Degree

Format: School - Degree

Father's Graduate School & Degree

Format: School - Degree

Father's Business Name *

Father's Occupation *

Father's Work Phone

Area CodePhone Number

Paternal Grandmother

First NameLast Name

Paternal Grandfather

First NameLast Name

Mother's Name*

First NameLast Name

Dr.Mrs.Ms.Other

Mother's Home Address (if different from applicant's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mother's Home Phone (if different from applicant's)

Area CodePhone Number

Mother's Cell Phone*

Area CodePhone Number

Mother's Email*

example@example.com

Mother's High School

Mother's Post High School

Mother's Shul(s) Attended

Mother's Undergraduate School and Degree

Format: School - Degree

Mother's Graduate School and Degree

Format: School - Degree

Mother's Business Name*

Mother's Occupation *

Mother's Work Phone

Area CodePhone Number

Maternal Grandmother

First NameLast Name

Maternal Grandfather

First NameLast Name

MarriedDivorcedRemarriedWidow(er)

If divorced, who has custody?

Who is responsible financially

With whom does the child primarily reside?

Applicant's Siblings*

Format: First Name - School - Current Grade

School(s) Attended*

Format: School Name - Grades - Years Attended

Please indicate what Masechtos the applicant learned in 6th-8th grade*

Format: Grade - Masechta

AlgebraHebrewOther

Please indicate any honors classes in which the applicant is enrolled:

Awards, prizes and scholarships applicant has received:

How did the applicant spend the last two summers:*

Format: Year - Camp/Program

YesNo

Does the applicant have any particular disabilities, special needs (physical, academic or emotional), or family issues?*

YesNo

If yes, please explain for what condition

YesNo

I hereby submit this application for admission of our son to Mesivta Ateres Yaakov of Greater Long Island for the school year beginning September 2023 and certify that the information in this application is complete and accurate.

We understand the following standards and, if admitted, agree to uphold them:

- An application to Mesivta Ateres Yaakov indicates commitment to the full program and its standards.

- All students are expected to uphold the religious and ethical principles of Mesivta Ateres Yaakov at all times, both in and out of the Mesivta.

- Regular attendance, promptness and satisfactory work are required in both departments and that students abide by all rules and responsibilities.

- Mesivta Ateres Yaakov offers a full four-year course of study dedicated to excellence in Torah, Academics, Middos and Personal Development and that the Mesivta does not endorse or facilitate early graduation.* Mesivta Ateres Yaakov has the right to require the withdrawal of any student at any time for disciplinary, educational reasons or any reasons at the discretion of Mesivta Ateres Yaakov.

- Final Acceptance to the Mesivta is contingent upon reaching full agreement of financial terms and the successful completion of all 8th grade requirements.

Applicant's Signature*

Mother's Signature*

Father's Signature*

Upload a Photo of Applicant.*

Upload a Photo of Applicant's Parents.*

My Products*

Application Fee$175.00

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

2023-2024 Admissions Application

Directions for Completing this Application:

Applicant's Information

APPLICANT'S FATHER: Information & Education

APPLICANT'S MOTHER: Information & Education

Family Information

Applicant's Academic Information

Principals' Evaluation

Financial Aid

Admission Agreement