SFJA New Student Information

SFJA New Student Application

Student Information
Child's Legal Name*

First NameLast Name
Child's Hebrew Name*
Child's Known Name if Different to Legal Name
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's D.O.B.*

MonthDayYear
Date of birth
Does your child have any siblings?*

YesNo
How many children?*
Current Grade Attending*
Child's Cell Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Child's Email
example@example.com
Upload Picture of your child*
Current School*
School Phone Number*

Area CodePhone Number
Grade Entering *
Math Grade Level *
Current grade level
Reading Grade Level *
Current grade level
Judaic Grade Level *
Current grade level
Past Expulsions / Suspensions*
If yes, Please list:*
What is your goal for your child(ren)?*
Health Information
Does your child have a IEP or any other test results*

YesNo
Upload all test results, recommendations, including IEPs.*
Does your child require any additional services*

NoPTOTSpeechABAOther
If yes, Please list:*
Does your child have any official diagnoses?*
If yes, Please list:*
Does your child have learning differences or challenges?*
If yes, Please list:*
Does your child have any allergies?*
If yes, what is your child allergic to?*
Does your child carry an EpiPen and/or Inhaler?*
Toilet Trained*

YesNo
Parents Information
Parent's Marital Status*
Student lives with*
Scholarships*
Mother's Name*

First NameLast Name
Mother's Hebrew Name*
Mother's Cell Phone Number*

Area CodePhone Number
Mother's Email*
example@example.com
Father's Name*

First NameLast Name
Father's Hebrew Name*
Father's Cell Phone Number*

Area CodePhone Number
Father's Email*
example@example.com
Congregation with which family is affiliated Name of Rabbi / Shul*
Is either the mother or father not born of Jewish faith *
Which parent was not born Jewish*
Is the conversion completed yet?*
Name of Rabbi who did conversion*
Rabbi Phone Number*

Area CodePhone Number
How did you hear about us?*
Tour Appointment Request
Terms and Conditions*
Mothers Signature*

Clear
Fathers Signature*

Clear

My Products*

New Student application fee$100.00

Enter coupon

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

SFJA New Student Application

Health Information

Parents Information