Application -Kol Yaakov Torah Center

NOTICE:

If you were looking for the Maimonides Retreat application, please click here.
For the Summer Horizons, please click here.
The application below is exclusively for enrollment in Kol Yaakov Torah Center.

Last Name
First Name
Hebrew name
Legal Address
City
State
Zip
Mailing Address (if different)
City
State
Zip
Cell phone
Home phone
E-mail Address
Date of Birth
Place of Birth
Country of Citizenship
Address where your parents or guardians reside:
Marital Status	Single Married Divorced
If married, wife's name
Number of Children
Were you ever in Israel?	Yes No
If yes, reason for visit
Parents' Marital Status	Married Divorced Separated Other
Languages spoken at home
Activities and organizations in which you have participated
Have you ever received any scholarship, awards or published original research?	Yes No
If yes, please give details
What are your areas of interest?	Chumash/Rashi Mishna Gemara Other
If other, what:
Would you rather study	Full Time Part Time
State goals after graduation from Kol Yaakov Torah Center
Do you need financial assistance in meeting the tuition requirement?	Yes No
Have you ever received federal financial aid?	Yes No
Was your mother born Jewish?	Yes No
If not, please explain.
Was your father born Jewish?	Yes No
If not, please explain.
Are these your birth parents?	Yes No
Secular Education
High School Attended
City
University Attended
Dates Attended University (mo/yr)	-
Degree awarded	AA BA/BS MA/MS Other
Credit status:	Fr So Jr Sr
Academic Major
Academic Minor
Jewish Education
Speaking:	Beginner Intermediate Advanced
Reading:	Beginner Intermediate Advanced
Writing:	Beginner Intermediate Advanced
Understanding:	Beginner Intermediate Advanced
How many months of formal study have you had previously in Hebrew Bible?
How many months of formal study have you had previously in Talmud?
Other Jewish texts?
Health
Have you ever been under the care of a mental health professional (e.g. psychiatrist, psychologist)?	Yes No
Have you ever taken prescription medication for a chronic mental or physical condition?	Yes No
If yes, please specify condition.
Specify any medical conditions.
Describe any learning disabilities.
Do you have any special dietary requirements?
Provide two references
Names	1. 2.
Relationships	1. 2.
Phone Numbers	1. 2.
What is your Jewish affiliation?	Reform Conservative Orthodox Unaffiliated Other
If other, please describe.
For Foreign Students Only
Date of Entry into US
Status	Green Card Student Visa Other