Yeshivas Chayeinu — 5787 Registration
Thank you for your interest in Yeshivas Chayeinu for the 5787 school year. Please complete each section below — your progress is saved automatically as you go. Rabbi Feldman personally reviews every application, and you'll hear from him directly within 1–2 days of submitting to begin the conversation.
Student Information
Hebrew First Name
*
Hebrew Last Name
*
Legal/English First Name
*
Legal/English Last Name
*
Date of Birth (Secular)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hebrew Date of Birth - Month
*
Please Select
Tishrei
Cheshvan
Kislev
Tevet
Shevat
Adar
Nisan
Iyar
Sivan
Tammuz
Av
Elul
Hebrew Date of Birth - Day
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Student Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student Email
*
example@example.com
Recent Photo of Student
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Current Situation
Grade/Shiur Applying For
*
Please Select
Shiur Aleph
Shiur Beis
Shiur Gimmel
Current Yeshiva/School
*
Principal's Name
*
First Name
Last Name
Principal's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Maggid Shiur (Teacher) Name
*
First Name
Last Name
Current Maggid Shiur (Teacher) Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Mashpia Name
*
First Name
Middle Name
Last Name
Current Mashpia Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Academic History
Where did the student learn last year?
*
Where did the student learn the year before?
*
Summer camps attended in the last 2 years
Briefly describe his experience at camp
Teacher or counselor reference name
*
First Name
Last Name
Reference phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Self-Assessment
Lashon Kodesh fluency
*
Perfect
Good
Needs work
Yiddish fluency
*
Perfect
Good
Needs work
Gemara skill level
*
Perfect
Good
Needs work
Parent/Guardian Information
Father's Name
*
First Name
Middle Name
Last Name
Father's Cell
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Email
*
example@example.com
Father's Occupation
Mother's Name
*
First Name
Middle Name
Last Name
Mother's Cell
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's Email
*
example@example.com
Mother's Occupation
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Contact
*
Please Select
Father
Mother
Student
Address
Street Address
*
City
*
State
*
ZIP Code
*
Tell Us About Your Son
Why would your son like to attend Yeshivas Chayeinu?
*
What values or ideals do you hope he will develop here?
*
Anything else about your son or family that would help support him
Where did you hear about Yeshivas Chayeinu?
*
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