Student Name
*
First Name
Last Name
Name He is Called By:
Student's Hebrew Name: (Please write it in Hebrew)
Cohen, Levi, Yisrael?
Hebrew Birthday (Day, Month, Year)
*
Student English Birthday
*
MM
DD
YYYY
Current Age
*
Which Shiur are you applying for?
Have you had a son at Mesivta previously?
*
Father's Title
*
Rabbi
Mr.
Dr.
Father's Name
*
Father's Occupation
*
Father's Phone Number
*
(###)
###
####
Father's Email Address
*
Mother's Title
*
Mrs.
Ms.
Dr.
Mother's Name
*
Mother's Phone Number
*
(###)
###
####
Mother's Email Address
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Please list the other Mesivta/s you are applying to:
Please describe your family’s technology, phone and electronic philosophy:
*
Do you have a smart phone?
*
Do you allow your children to have smart phones?
*
What other does technology and or electronics do you have in your home?
*
What technology and electronic gadgets does the applicant have access to or own?*
*
I understand that the Yeshiva’s policy requires kosher phone certification and acceptance into the Mesivta is contingent on compliance with our phone and technology policies Please sign below:
*
Name of Hebrew Principal
*
Principal's Phone Number
*
(###)
###
####
Principal's Email Address
*
Primary Teacher's Name
*
Teacher's Phone Number
*
(###)
###
####
Teacher's Email Address
*
Name of Hebrew Principal
*
Principal's Phone Number
*
(###)
###
####
Principal's Email Address
*
Primary Teacher's Name
*
Teacher's Phone Number
*
(###)
###
####
Teacher's Email Address
*
Counselor's Name
*
Phone
(###)
###
####
Learning Teacher's Name
*
Phone
(###)
###
####
Counselor's Name
*
Phone
(###)
###
####
Learning Teacher's Name
*
Phone
(###)
###
####
Please choose your child's learning level
*
Excellent
Good
Average
Below Average
Did he require any extra academic assistance in the past?
*
If you answered yes to the above, please explain.
Has he had any trouble with Kriah?
*
If you answered yes to the above, please explain.
Do you think that your son will need extra assistance with any of his studies in the coming year?
*
If you answered yes to the above, please explain.
Did he start studying Gemorah?
*
If yes, when did he begin?
Has he had any trouble with Gemorah?
If you answered yes to the above, please explain.
Can he understand a conversation in Yiddish?
*
Excellent
Medium
Poor
Can he speak Yiddish?
*
Excellent
Medium
Poor
Can he read and understand a sicha in Yiddish?
*
Excellent
Medium
Poor
What are his current standards in regards to Chitas, Rambam, dress?
*
Which books and areas in Torah and Chassidus has he read?
*
What does he aspire to?
*
Are there areas in Chassidishkeit and Yiras Shomayim that you would like the yeshiva to focus on with your Bochur?
*
Does your son have any medical issues?
*
Does your son have any allergies?
*
Does your son have any dietary needs?
*
Does your son take any medication?
*
As far as you know, will he require any extra attention/care for health/medical needs in the coming year?
*
If you answered yes to one of the above, please explain.
Please describe your child's social skills:
*
Has your son experienced trouble in his social interactions?
*
Does your son have any challenges in the emotional arena?
*
Did he require in the past any extra assistance through school or outside of school?
*
Has your son been diagnosed or experiencing symptoms of ADD/ADHD?
*
Does your son experience anxiety related issues?
*
Has your son had any diagnosis in any area?
*
Has your son been away from home before?
*
Does your son have any sleep issues?
*
Has your son experienced any type of trauma or been through a difficult experience?
*
Do you think your son will need extra assistance/attention in this area or in any area in the upcoming year?
*
If you answered yes to one of the above, please explain.
Please describe any other information you would like us to know regarding your child:
I understand that if my child is accepted Mayan Torah Mesivta, I accept the rules and regulations of the school. Please type your first and last name as your sign of agreement:
*
First Name
Last Name
Email of Parent filling out form
*
I have sent in Zelle/CC to cover the fee.
*
Please note applications will only be accepted after the fee has been submitted