STUDENT INFORMATION
FIRST NAME(S)
LAST NAME
NAME OF PREFERENCE
FULL HEBREW NAME INCLUDING YOUR MOTHER’S NAME
DATE OF BIRTH
HEBREW BIRTHDAY
PLACE OF BIRTH
STREET NAME AND NUMBER
CITY
ZIP CODE
COUNTRY
Email
HOME PHONE
CELL PHONE
LAST 4 DIGITS OF YOUR SOCIAL SECURITY
FULL SIZE PHOTO OF CURRENT PASSPORT
REFERENCE LETTER 1
REFERENCE LETTER 2
SCHOOL PRESENTLY ATTENDING
NAME OF PRINCIPAL
EMAIL OF SCHOOL PRINCIPAL
EMAIL OF SCHOOL SECRETARY
ELEMENTARY SCHOOL ATTENDED
LOCATION
HIGH SCHOOL ATTENDED
LOCATION
REASON FOR CHANGE IF ANY
NAME THE CAMP(S) YOU HAVE ATTENDED IN THE LAST 3 YEARS LIST ANY SCHOLARSHIPS, PRIZES, AWARDS YOU HAVE RECEIVED
UPLOAD CERTIFICATES RECEIVED
CHUMASH AND RASHI - STATE WHICH
PROPHETS – STATE WHICH
WRITINGS / MEGILLAS – STATE WHICH
HALACHA – STATE WHICH
CHASSIDUT MAAMER – STATE WHICH
TANYA – STATE WHICH CHAPTERS
THE LANGUAGE OF INSTRUCTION IN LIMUDEI HAKODESH WAS
CAN YOU UNDERSTAND A LESSON CONDUCTED IN HEBREW?
CAN YOU UNDERSTAND A LESSON CONDUCTED IN HEBREW?
DO YOU SPEAK HEBREW?
WHAT LANGUAGE BESIDES ENGLISH IS SPOKEN AT HOME?
WHAT SUBJECT DO YOU LIKE THE MOST?
WHAT SUBJECT DO YOU LIKE THE LEAST?
STUDENT TRANSCRIPT GRADES 9 THRU 11
FATHER’S NAME
FATHER’S CELL
BUSINESS TEL
FATHER’S EMAIL
FATHER’S COUNTRY OF BIRTH
FATHER’S OCCUPATION
MOTHER’S NAME
MOTHER’S MAIDEN NAME
MOTHER’S EMAIL
HOME PHONE
MOTHER’S CELL
CELL AT WORK
MOTHER’S COUNTRY OF BIRTH
MOTHER’S OCCUPATION
LIST ALL OF THE CHILDREN IN YOUR FAMILY IN AGE ORDER AND SCHOOLS ATTENDING(ED)
PERSONALITY – HOW WOULD YOUR FRIENDS DESCRIBE YOU?
ACADEMIC – CURIOUS, DILIGENT, LOVE OF LEARNING, PARTICIPATION ETC?
TALENTS – ART, MUSIC, VOCAL, WRITING, DRAMA, ORGANIZATION?
USE ONLY 3 WORDS TO DESCRIBE WHAT SEMINARY MEANS TO YOU
WHAT DO YOU LIKE TO CONTRIBUTE TO SOCIETY?
IS SEMINARY CHAYA MUSHKA YOUR FIRST CHOICE?
WRITE AN ESSAY ABOUT WHY YOU WANT TO ATTEND SEMINARY CHAYA MUSHKA
UPLOAD COMPLETED SELF-EVALUATION FORM
UPLOAD MEDICAL FORM SIGNED AND STAMPED BY YOUR MEDICAL PROVIDER HERE:
UPLOAD YOUR IMMUNIZATION RECORDS HERE:
Submit and proceed to schedule an interview
