Application for Admission

Date of Application

Month Day Year

Full Name of Applicant*

First Name Middle Name Last Name Gender

Preferred Name/Nickname

If Applicable

Grade Applying for*

Choose One

Birth Date*

Month Day Year

Birth Place

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone Number

Area Code Phone Number

Applicant lives with

ParentsMotherFather

Is the applicant adopted? Optional

YesNo

Did the applicant or a family member go through a conversion?*

YesNo

Jewish Affiliation

Applicant Current School and Grade*

School Grade

School Head or Principal

Name

School Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

School Phone Number

Area Code Phone Number

Please list all schools Applicant has attended and provide dates of attendance.

Parent/Guardian #1*

Title First Name Last Name

Home Address

If not the same as above

Cell Phone Number*

Area Code Phone Number

E-mail* This email will receive submission confirmation/receipt

Occupation/Place of Business*

Job Title

Business Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Business Phone

Area Code Phone Number

Relationship to Applicant*

Parent Marital Status *

Parent/Guardian #2

Title First Name Last Name

Home Address #2

If not the same as above

Cell Phone Number #2

Area Code Phone Number

E-mail #2

Occupation/Place of Business #2

Job Title #2

Business Address #2

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Business Phone #2

Area Code Phone Number

Relationship to Applicant #2

Parent Marital Status #2

Custody If applicable

Sibling Information Please enter name, age, and school of sibling

Sibling Name School Attending Age

Additional Sibling Information* If more than will fit above

How did you hear about the Hebrew Academy?*

Name and relationship of any friends/relatives who have attended Hebrew Academy?

How would you describe your child's personality?*

My child excels at...

Please describe the educational environment that you are seeking for your child.

What would you like us to know about your child?

What are your expectations of your child's Hebrew Academy educational experience?

How would you describe your child's academic performance to date?*

Tell us about any special interests/talents in music, art, religion, athletics, academics, or other are that your child has.

Has your child ever received academic support or tutoring outside the school setting?*

YesNo

What was the reason?

Please describe any special requirements that your child may have (e.g. medications, attention to allergies, dietary restrictions, etc.)*

Has a previous school recommended that your child receive

Will the family be applying for Financial Aid? This form must be completed in order to be considered for scholarship.

YesNo

Full Name of Parents/Guardians* If BOTH PARENTS are living, please include BOTH names below.

Parent/Guardian #1 Parent/Guardian #2 Last Name

A non-refundable application fee of $100 must be submitted with this application.

Payment Processing fee will be added to all credit card transactions. (AMEX - 4% , all other cards 3%)

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Application for Admission

Application for Admission

Student Information

Current/Previous School Information

Family Information

Educational Assessment

Signature

LOWER SCHOOL

MIDDLE SCHOOL

HIGH SCHOOL