Chazon Shlomo Application
Please fill out this form below and we will be in touch with you soon. Thank you.
Email address *
Contact Information
First Name *
Last Name *
Phone number *
Permanent address *
Email Address *
Personal Information
Gender *
Birthday *
MM
/
DD
/
YYYY
Father's first and last name
Mother's first and last name *
Where you born Jewish? *
Was your mother born Jewish? *
Mental Health
Do you have any medical or emotional conditions? *
If yes, please describe
Are you currently taking any medication? *
Please list any physical restrictions: *
Is there anything else you feel we should know about your health in order to provide you with the best experience possible?: *
Educational background
Name of high school *
Name of post high school university or Yeshiva *
Please rate your Hebrew reading proficiency *
Unable
Fluent
Please rate your Hebrew comprehension proficiency *
Unable
Fluent
Please describe your motivation for applying to Yeshivat Simchat Shlomo Smicha Program *
Course of Study
Clear selection
Please provide two references including: Name, phone number and email address: *
Would you be interested in a dorm?
Clear selection
References
Please provide us with two letters of reference. Below please provide us with the names, phone number and email address of both of your references.
1. Name, phone number, email address
2. Name, phone number, email address
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