Admissions Form 2018-19

APPLICATION FOR ADMISSION - Part I

Enter your admission information below - Two Part Form
Today's Date *

Month Day Year
Applying for School Year: *
Applying for Grade Level: *
APPLICANT INFORMATION
Name *

First Name Middle Initial Last Name
Hebrew Name (optional)
Nickname (optional)
Birth Date *

Month Day Year
Birth Place: *
Gender *

Male Female
Primary Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone *

Area Code Phone Number
E-mail Address *
Language(s) Spoken at Home: *
Synagogue Affiliation (if any):
PARENT/LEGAL GUARDIAN INFORMATION
Parent/Legal Guardian #1
Full Name *

First Name Last Name
Relationship to Applicant *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number *

Area Code Phone Number
Occupation/Employer *
Work Phone Number

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
Parent/Legal Guardian #2
Full Name

First Name Last Name
Relationship to Applicant
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number

Area Code Phone Number
Occupation/Employer
Work Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Parent/Legal Guardian #3

Extra Contact Person (if needed)
Full Name

First Name Last Name
Relationship to Applicant
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number

Area Code Phone Number
Occupation/Employer
Work Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Applicant Living Arrangements
Applicant Lives with: *

Mother Father Both
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 info needed?
Applicant's Siblings
Full Name

First Name Last Name
Date of Birth

Month Day Year
School
Full Name

First Name Last Name
Date of Birth

Month Day Year
School
Full Name

First Name Last Name
Date of Birth

Month Day Year
School

Part II - Short Answer Questions
How did you learn about JCDSRI?
Is your child toilet trained?
Children must be toilet trained to enter our Pre-K program.
Tell us about your Jewish background and your family's Jewish practice? *
Will You Be Applying For Financial Aid? *

Yes No
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? *
What would you like us to know about your child? *
Why do you think that JCDSRI might be a good fit for your child? *
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 submitte the $50 application fee via the Paypal link as well as the supplementary application forms.
Parent/Legal Guardian #1 Signature *
Parent/Legal Guardian #2 Signature
Should be Empty:

APPLICATION FOR ADMISSION - Part I

APPLICANT INFORMATION

PARENT/LEGAL GUARDIAN INFORMATION

Parent/Legal Guardian #1

Parent/Legal Guardian #2

Parent/Legal Guardian #3

Applicant Living Arrangements

Applicant's School Information

Applicant's Siblings

Part II - Short Answer Questions