Grade 9 Application Form

Applications are due by Friday, January 12, 2024 at 4:00 pm.

Applicant Information

Last Name

Legal Given Name

Hebrew Given Name

Preferred First Name

Place of Birth

Date of Birth

Parent Information

Father's Last Name

Father's Title

Mother's Last Name (if different)

Mother's Title

Father's First Name

Mother's First Name

Home Address

Mother's Home Address (if different)

Home Telephone

Mother's Home Telephone (if different)

Father's Occupation

Mother's Occupation

Father's Cell Phone

Mother's Cell Phone

Father's Email Address

Mother's Email Address

Marital Status

If divorced/separated, custody is awarded to:

References

Current Limudai Kodesh Rebbe(Required)

Rebbe's Email Address(Required)

Current General Studies Teacher(Required)

Teacher's Email Address(Required)

The above references will be asked to complete confidential written evaluations of the applicant.

Synagogue/Religious Affiliation

To what Synagogue does your family belong?

Who is your family’s Rabbi?

Applicant’s Siblings

Name

Age

School

Grade

Name

Age

School

Grade

Name

Age

School

Grade

Name

Age

School

Grade

Camps Applicant Attended

Camp

Years

Camp

Years

Camp

Years

Camp

Years

Camp

Years

Camp

Years

Heath Questionnaire - To Be Completed by Parents

Is your son presently under the care of a health-care professional (e.g., physician, orthodontist, psychiatrist, psychologist, physical therapist)? If yes, for what condition?

Does your son currently take any medication? If yes, what is the drug and what are the supervision requirements?

Has your son experienced learning/behavior difficulties? Has he ever been assessed for ADD/ADHD or learning disabilities? If yes, attach any written reports you may have.

You can attach files below or send any reports to [email protected].

File

Max. file size: 100 MB.

File

Max. file size: 100 MB.

File

Max. file size: 100 MB.

Has your son required medication in the past for behavior or learning problems (e.g. ADHD)? If yes, please explain.

Has your son received any of the following services – either privately or in school – within the past three years: speech or language therapy, occupational therapy, physical therapy, psychological services, or special education intervention?

Attachments

To complete the application, you must submit the files listed below. You may scan these items and submit them as file attachments.

A photograph of the applicant.(Required)

Max. file size: 100 MB.

Transcripts from Grade 6(Required)

Max. file size: 100 MB.

Transcripts from Grade 7(Required)

Max. file size: 100 MB.

An essay of approximately 250 words in which you tell us about yourself and respond to the questions below.(Required)

What are your greatest strengths and weaknesses? What challenges to you anticipate facing in high school? What are your educational and career goals after high school? The essay must be handwritten, typed or printed essays will not be considered.

Max. file size: 100 MB.

Parent-Student Statement

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Applicant

First Last

Father

First Last

Mother

First Last

Date

Email Address(Required)

Enter Email Confirm Email

Phone

This field is for validation purposes and should be left unchanged.