Application

THE PRAGUE SEMINARY

APPLICATION FORM 5786
Full English Name*

First NameMiddle NameLast Name
Full Hebrew Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Hebrew D. O. B.*
Email*
Nationality*
Please list all passports
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Elementary School*
High School (If more than 1, please list all)*
Current Teacher*

First NameLast Name
Teachers' Phone Number*
Please enter a valid phone number.
Teachers' email*
Have you applied to another Seminary?*

YesNo
Which*
Which seminary is your first choice?*
Have any of your friends applied to The Prague Seminary as well?*

YesNo
Please specify*

1 Recent personal picture*

Cancelof
1 Recent family picture*

Cancelof
Passport copy*

Cancelof

Parents Marital Status*
Fathers Name*

First NameLast Name
Fathers Phone Number*
Fathers Email Address*
Occupation*
Mothers Name*

First NameLast NameMaiden Name
Mothers Phone Number*
Mothers Email Address*
Occupation*

Current Mechaneches*

First NameLast Name
Mechaneches Phone Number*
Mechaneches Email*

What two Chassidishe Hanhagos are ingrained in you?*
Do you say Chitas daily?*

YesNo
Are you able to read and understand a Sicha on your own?*

YesNo

Before continuing, please read the seminary Tznius guidelines carefully.

Tznius:*

	Always	Not always
Elbows fully covered
Knees fully covered
Neckline fully covered

Why would you like to spend the upcoming year as a תלמידה in the Prague seminary?*

What are your past Shlichus experiences? *
If none, write 'none'.
Where have you spent the first month of this past summer?*
Name the Camp\Shlichus
What was your position?*
Where have you spent the second month of this past summer?*
Name the Camp\Shlichus
What was your position?*

Reference #1*

First NameLast Name
Email*
Phone Number*
Relationship *
Reference #2*

First NameLast Name
Email*
Phone Number*
Relationship *

Attached you will find additional forms to complete your application:

Evaluation form

Health Declaration form

Physician form

Parent Agreement form

Electronic Device form

Dress Code

Takanon

Please download them now prior to submitting this form, and have your parents and physician fill & sign the forms, and email them back to us, together in one email.

Please type your full name in the email subject.

The evaluation form should be filled, signed and sent to us by your Mechaneches.

Your application is not completed until we have recieved all 5 forms, and Mechaneches form. Once your application is complete, we will contact you by email regarding the follow-up interview.

Once you have downloaded these forms, click Next below.

Application payment*

Application fee

$80.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

By submitting my application, I understand that my success in Seminary is dependent on my full adherence to the rules and guidelines that will be outlined, in and out of seminary. I realize that breaching seminary rules will carry serious consequences, and may result in dismissal from Seminary.
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