JCDSRI Application Form

APPLICATION FOR ADMISSION
Today's Date*

MonthDayYear
Applying for School Year: *
Applying for Grade Level:*
APPLICANT'S INFORMATION
Student's Name*

First NameMiddle InitialLast Name
Hebrew Name (optional)
Nickname (optional)
Gender*
Birth Date*

MonthDayYear
Birth Place: *
Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Applicant Lives with:*

Parent #1Parent #2BothOther
Phone*

Area CodePhone Number
Language(s) Spoken at Home:*
Synagogue Affiliation (if any):
PARENT/LEGAL GUARDIAN INFORMATION
Parent/Legal Guardian #1
Full Name*

First NameLast Name
Relationship to Applicant*
E-mail Address*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number*

Area CodePhone Number
Occupation/Employer*
Cell Phone Number*

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Parent/Legal Guardian #2
Full Name

First NameLast Name
Relationship to Applicant
E-mail Address
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Area CodePhone Number
Occupation/Employer
Cell Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Applicant's School Information

List schools attended within past 2 years, most recent first
Name of School*
Dates Attended*
Name of School
Dates Attended
Any extra information you would like to share?
Applicant's Siblings
Sibling 1 - Full Name

First NameLast Name
Date of Birth

MonthDayYear
School
Sibling 2 - Full Name

First NameLast Name
Date of Birth

MonthDayYear
School
Sibling 3 - Full Name

First NameLast Name
Date of Birth

MonthDayYear
School

Schedule Selection for Students Entering Nitzanim and Ilanot (our 3 and 4-year-old classes)

We offer a flexible schedule for students in our 3 and 4-year-old classes. Students can attend school for half days (7:45 a.m. - 12:00 p.m.) or full days (7:45 a.m. - 3:15 p.m. Monday through Thursday and 7:45 a.m. - 2:30 p.m. on Fridays). Students can also choose to attend 3 to 5 days per week. Please indicate your preferred schedule for your child below. (This schedule selection is NOT binding. Let us know your plans to the best of your availability and we will confirm your child's schedule later in the application process.)
Monday
Tuesday
Wednesday
Thursday
Friday

Short Answer Questions
How did you learn about JCDSRI?
Is your child toilet trained?
Children must be toilet trained to enter JCDSRI.
Will you be applying for Financial Aid?*

YesNo
We look forward to getting to know your child and your family. Please answer the following questions. The information you provide will only be used for admissions purposes and will not become part of your child's permanent record.
What three words best describe your child?*
Tell us about your Jewish background and your family's Jewish practice?*
What would you like us to know about your child?*
Why do you think that JCDSRI might be a good fit for your child?*
Has your child received services through Early Intervention or privately to support their learning or development? Has your child been assessed for services? If yes to either of these questions, please share what they have received services for and provide any other pertinent details about their progress.*
Are there any special issues in your child's history of which the school should be aware?*
Please sign and submit this application. You will then be directed to a Paypal link. Your application will not be complete until you have submitted the $75 application fee via the Paypal link as well as the supplementary application forms.
Parent/Legal Guardian #1 Signature*
Parent/Legal Guardian #2 Signature
Application Fee $75*

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USDApplication Form
Should be Empty:

APPLICATION FOR ADMISSION

APPLICANT'S INFORMATION

PARENT/LEGAL GUARDIAN INFORMATION

Parent/Legal Guardian #1

Parent/Legal Guardian #2

Applicant's School Information

Applicant's Siblings

Schedule Selection for Students Entering Nitzanim and Ilanot (our 3 and 4-year-old classes)

Short Answer Questions