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. Once submitted, please allow a few business days for our Hanhalla to review your application, after which we will follow up regarding next steps.
Student Information
Hebrew First Name
*
Hebrew Last Name
*
Legal/English First Name
*
Legal/English Last Name
*
Date of Birth (Secular)
*
-
Month
-
Day
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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