Application "*" indicates required fields Δ Applicant InformationName* First Middle Last Hebrew Name*Informal Name*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student's Email Phone*Home Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is the mailing address the same as the home address?* Yes No Mailing Address:* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country I am a:* US Citizen Permanent Resident Other Social Security #*OtherPrevious EducationAre you a High School Graduate?* Yes No List chronologically all the High Schools\Mesiftos you have attended*Name of schoolLocationDates of AttendanceGraduation Date Add RemoveHave you ever attended a post-secondary institution?* Yes No (include Bais Medrash, college, and post-secondary vocational programs) List chronologically all the post-secondary institutions you have attended*Name of schoolLocationDates of AttendanceDegree Awarded Add RemoveI hereby apply for enrollment as a regular student at Yeshiva Zichron Aryeh for the purpose of obtaining a First Talmudic Degree. I certify that all the information contained on this application is accurate and complete to the best of my knowledge. I further understand that I must remain in compliance of all of Yeshiva Zichron Aryeh rules and regulations as described in the catalog and other official notices and publications. Father/Guardian InformationFather's Name* Mr.RabbiDr. Title First Last Mother's Name* Mrs.Dr.Ms. Prefix First Last Father's OccupationMother's OccupationFather's CellMother's CellFather's Email Mother's Email Student's Marital Status Single Married Wife's NameIn-laws' Name* First Last In-laws' TelephoneIn-laws' Email In-laws' Address Street Address City State / Province / Region ZIP / Postal Code Paternal Grandparents Name* First Last Email Paternal Grandparents TelephonePaternal Grandparents Address Street Address City State / Province / Region ZIP / Postal Code Maternal Grandparents Name* First Last Maternal Grandparents TelephoneEmail Maternal Grandparents Address Street Address City State / Province / Region ZIP / Postal Code PLEASE ENCLOSE PROOF OF HIGH SCHOOL GRADUATION OR COMPLETION WITH YOUR APPLICATION (A copy of your diploma, transcripts or a letter from the graduating school will suffice) Proof of High School Graduation Drop files here or Select files Max. file size: 100 MB. PLEASE ENCLOSE A COPY OF INSURANCE CARD AND PROOF OF IMMUNIZATION WITH APPLICATIONInsurance Card Drop files here or Select files Max. file size: 100 MB. Proof of Immunization Drop files here or Select files Max. file size: 100 MB. Does the Applicant have any medical conditions that may affect him while attending Yeshiva?*Medical Insurance company*Blood type*Name of your last Rebbe:*Phone*How many daily Gemora Sedorim were in your last Yeshiva program?*How long was each one?*Evaluate your past year’s learning including hasmodo, leining ability and general progress*Will you be attending college while in Yeshiva?* Yes No Which one?What is your major?*Expected date of graduation*List all part-time or full-time jobs you have held in the past two years*How has the Applicant spent the last three summers* Add RemoveWhat factors were involved in the Applicant’s decision to apply to our Yeshiva? Explain*Who referred you to Zichron Aryeh?*TuitionThe following is the fee schedule for the school year: Tuition – $9,750 Room – $4,000 Board – $4,000 Registration – $750 Total – $18,500Dormitory and Meals* I am requesting a bed in the dormitory. I do not want a bed in the dorm but want to eat meals in Yeshiva. I do not want a bed in the dormitory nor do I want to eat any meals in Yeshiva. Please check appropriately:* I will be paying the full tuition of $18,500, if my son is accepted and enrolled in Yeshiva Zichron Aryeh I will not be able to pay the full tuition and would like to request a scholarship if my son is accepted and enrolled in Yeshiva Zichron Aryeh Please check appropriately:* I will be paying the full tuition of $14,500, if my son is accepted and enrolled in Yeshiva Zichron Aryeh I will not be able to pay the full tuition and would like to request a scholarship if my son is accepted and enrolled in Yeshiva Zichron Aryeh Please check appropriately:* I will be paying the full tuition of $10,500, if my son is accepted and enrolled in Yeshiva Zichron Aryeh I will not be able to pay the full tuition and would like to request a scholarship if my son is accepted and enrolled in Yeshiva Zichron Aryeh I would like a scholarship of $I would pay a total of $*Scholarship availability will be determined by the tuition committee.PLEASE NOTE: In order to continue the enrollment process, this form MUST be received by the Yeshiva. The enrollment process will be considered complete and the student will be permitted to attend ONLY after the Yeshiva receives all of the required forms and payments as per the enrollment contractName First Last
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