Application for Admission 2025-26

Application for Admission

2025-2026
Perspective Student Information
I wish to be admitted to Grade * for the * school year.
Student Name - English*

First NameLast Name
Student Name - Hebrew*
Place of Birth*
Date of Birth - English*

MonthDayYear
Date
Date of Birth - Hebrew*
Social Security Number*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone*
Please enter a valid phone number.
Student Cell Phone
Please enter a valid phone number.
Student Email Address*
example@example.com
Does the student currently live at home with her parents? If no, please explain. *
Current School*
Current Grade*

8th9th10th
Please upload applicant's most recent report cards including Judaic and General Studies. *

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Please upload applicant's previous years' report card include Judaic and General Studies. EX: If applicant is in 8th grade, please submit 7th grade report cards here.*

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Family Information

Please list the names, ages, schools and grades of all children in the family
Name Age    School    Grade
Name   Age   School   Grade
Name   Age   School   Grade
Name   Age   School   Grade
Name   Age   School   Grade
Name   Age   School   Grade
Previous Schools

Please list all schools that applicant has attended. Enter 0 for any remaining fields.
School   Grades Attended   Years Attended
School   Grades Attended   Years Attended
School   Grades Attended   Years Attended
School   Grades Attended   Years Attended
Summer Camps

Please list all schools that applicant has attended. Enter 0 for any remaining fields.
Camp   Years Attended   Position Held
Camp   Years Attended   Position Held
Camp   Years Attended   Position Held

Student Profile

To be completed by the applicant
SHORT ANSWER QUESTIONS
How would you describe yourself in 5 words?*
List 3 accomplishments that you are proud of:*
List 2 areas in which you hope to grow:*
Why do you want to attend Chaviva High School?*
PERSONAL ESSAY
At the heart of Chaviva High School is our commitment to Leadership, Empowerment, Connection, and Purpose. Write an essay in the space below about one of those four core principles. Define what it means, share your personal experiences with it, and explore how it can impact your high school experience. *

Personal Information

Confidential When Completed and Signed Please note: In order to provide the most appropriate educational environment for your daughter, it is crucial for the school to have a full picture of your daughter's educational and medical background. Please indicate not applicable where necessary.
Please list all medication that your daughter takes on a regular basis, including non-prescription drugs and vitamins and their frequency.*
Please list all major operations/surgeries relevant to school life and activities.*
Has your daughter ever been assessed educationally or psycho-educationally?
If you answered yes to the previous question, please upload assessment documents such as an IEP, or neuro-psych evaluation.

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Please list 2 people who can be contacted as references

References should not be a relative of the applicant.
Reference 1 - someone who can speak of the applicant as a student in the classroom*

First NameLast Name
Reference 1 Relationship to Applicant*
Reference 1 Phone Number*
Please enter a valid phone number.
Reference 2 - someone who can speak of the applicant's character as a Bas Yisrael*

First NameLast Name
Reference 2 Relationship to Applicant*
Reference 2 Phone Number*
Please enter a valid phone number.

Before submitting an application, all prospective students and their parents must read through the Chaviva Student and Parent Guidebook. Click here to read. Please acknowledge that you have done so below.
I have read the Student Guidebook Signature of Parent*

Clear
I have read the Student Guidebook. Signature of Student*

Clear
Date*

MonthDayYear
Date
Please list any questions you have about Chaviva High School.*
Should be Empty:

Application for Admission