APPLICANT INFO
Name
*
First Name
Last Name
Middle Name
Hebrew Name
*
Prefers to be addressed as
*
Date of Birth
*
/
Month
/
Day
Year
Date
Place of Birth
*
Social Security Number
*
Home Phone Number
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Year of Yeshiva Applying For
*
1st Year BM
2nd Year BM
3rd Year BM
Present Yeshiva
*
Applicant's Email Address
*
Applicant's Phone Number
*
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FATHER'S INFO
Name
*
Rabbi
Dr.
Mr.
Prefix
First Name
Last Name
Place of Birth
*
Cell Phone Number
*
Email Address
*
Business Name/Position
Business Phone
Home Address
*
Same as Above
Different Address
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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MOTHER'S INFO
Name
*
Mrs.
Dr.
Prefix
First Name
Last Name
Place of Birth
*
Cell Phone Number
*
Email Address
*
Business Name/Position
Business Phone
Home Address
*
Same as Above
Different Address
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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SIBLINGS
NAME
AGE
GRADE
SCHOOL
SIBLING 1
SIBLING 2
SIBLING 3
SIBLING 4
SIBLING 5
SIBLING 6
SILBLING 7
SILBLING 8
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EDUCATION
List the schools that you have attended.
*
SCHOOL 1
SCHOOL 2
SCHOOL 3
NAME OF SCHOOL
ADDRESS
DATES ATTENDED
GRADUATED Y/N
Describe the courses taken this year (Include Limudei Kodesh)
*
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QUESTIONS
What subject do you like best?
*
What subject do you find most difficult?
*
What is your life's ambition?
*
List hobbies, musical and artistic talents, and sports abilities:
*
List any needs you might have (academic, emotional, social, medical):
*
List the organizations/extra curricular activities in which you have participated in your school and your community:
*
List the summer camps you have attended:
CAMP 1
CAMP 2
CAMP 3
NAME OF CAMP
CITY/STATE
CAPACITY
DATES ATTENDED
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REFERENCES
Name of Shul Rav
*
Phone Number
*
Please enter a valid phone number.
Name of Current Rebbe
*
Phone Number
*
Please enter a valid phone number.
Name of Last Year's Rebbe
*
Phone Number
*
Please enter a valid phone number.
Name of Current Menahel
*
Phone Number
*
Please enter a valid phone number.
Other Reference
*
Phone Number
*
Please enter a valid phone number.
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EMERGENCY CONTACT INFO
Emergency Contact 1
*
First Name
Last Name
Relationship
*
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
*
Please enter a valid phone number.
Emergency Contact 2
*
First Name
Last Name
Relationship
*
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
*
Please enter a valid phone number.
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AUTHORIZATION
IT IS UNDERSTOOD THAT THE REGISTRATION OF ALL STUDENTS ADMITTED TO THE YESHIVA OF CLEVELAND IS SUBJECT TO THE FOLLOWING CONDITIONS: ATTENDANCE AT THE YESHIVA IS A PRIVILEGE AND NOT A RIGHT. IN CONSULTATION WITH PARENTS, YOC RESERVES THE RIGHT TO REQUIRE THE WITHDRAWAL OF ANY STUDENT. ATTENDANCE AT YOC IS DEPENDENT UPON THE CONSISTENT COMPLETION OF ALL LEARNING ACTIVITIES TO THE BEST OF THE STUDENT’S ABILITIES, IN ALL STUDIES. THE STUDENT IS REQUIRED TO FAMILIARIZE HIMSELF WITH AND TO ABIDE BY THE RULES AND REGULATIONS OF THE YESHIVA. STUDENTS ARE EXPECTED TO UPHOLD THE MORAL PRINCIPALS AND GOOD NAME OF THE YESHIVA AT ALL TIMES – BOTH IN SCHOOL AND IN THEIR OUTSIDE ACTIVITIES. I HEREBY CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS COMPLETE AND ACCURATE.
Applicant's Signature
*
Date
*
/
Month
/
Day
Year
Date
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SUBMIT
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