General Information
Applicant's First Name: *
Applicant's Last Name: *
Date Of Birth: *
Age: *
How Did You Hear About The Program? *
Please Enter The Name Of The Referring Individual Or Organization, If Applicable: *
Country Of Birth: *
Applicant's Home Address: *
Home Phone #: *
Cell Phone #: *
E-Mail Address: *
Marital Status Of Applicant: *
School and Employment Information
List All Post-High School And Secondary Schools You've Attended. Include School Name, Major, Date (To-From), And Whether You Have Graduated From There: *
Years Of School Completed, Including First Grade: *
Please List Any Extracurricular Activities, Organizations, Or Hobbies You Are Involved With, Including Any Positions Of Leadership You Have Held: *
List Any Honors (Academic Or Otherwise) You Have Been Awarded: *
Current Employer, If Any: *
Please List The Last Three Jobs Or Internships: *
Family Information
Parents' Home Address: *
Parents' Home Phone #: *
Mother's First Name: *
Mother's Last Name: *
Mother's Occupation: *
Father's First Name: *
Father's Last Name: *
Father's Occupation: *
Parents' Marital Status: *
Was Your Biological Father Born Jewish? Please Summarize Conversion History, If Any: *
Was Your Biological Mother Born Jewish? Please Summarize Conversion History, If Any: *
Parents' Jewish Affiliation (Reform, Conservative, Orthodox, None, Etc.): *
Were All Of Your Grandparents Born Jewish? If Not, Please Explain: *
Jewish Background
Did You Attend Hebrew School, And If So, For How Many Years: *
What Was The Jewish Affiliation Of Your Hebrew School? (Reform, Conservative, Orthodox, None, Etc.): *
Did You Have A Bar Mitzvah: *
Did You Attend Jewish Day School? If So, Please List The Name(S) And The Number Of Years Attended: *
What Was The Jewish Affiliation Of Your Day School? (Reform, Conservative, Orthodox, None, Etc.): *
What Is Your Current, Personal Jewish Affiliation? (Reform, Conservative, Orthodox, None, Etc.): *
How Would You Describe Your Current Hebrew Reading Skills, Writing Skills, And Overall Hebrew Language Comprehension: *
Have You Ever Learned Talmud Before? Please Describe Your Level Of Proficiency, If Any, With Talmud And Mishnah Studies: *
Have You Ever Held A Leadership Position In A Jewish Organization? If So, Please List: *
Have You Ever Been To Israel Before, And If So, In What Context: *
Two References
Please include the name, address, phone number, and relationship to you, as well as the best time of day he or she can be reached. Please do not include family or friends.
Reference 1: *
Reference 2: *
Special Requirements
Do You Have Any Accessibility Requirements Or Physical Limitations Or Restrictions? If So, Please Elaborate:
Do You Have Any Special Dietary Requirements Or Restrictions (Other Than Kosher)? If So, Please Elaborate:
Are You Currently Receiving Medical Treatment? If So, Please Elaborate:
Are You Currently Receiving Any Treatment, Or Have You Ever Received Any Treatment For A Psychological Condition? This Can Include, But Isn't Limited To, Depression, Anxiety Disorder, Counseling, Etc. If So, Please Elaborate:
Are You Currently Taking Any Medication? If So, Please Elaborate:
Have You Ever Been Hospitalized For A Psychological Or Physical Condition? If So, Please Describe:
Do You Have Any Learning Disabilites That Are Relevant To Your Year Of Study With Aish Passaic? If So, Please Elaborate:
Essay
Please use the question below as an opportunity to tell us more about yourself and help the admissions committee have a broader picture of who you are as an applicant and as an individual.
Why are you applying to the Aish Passaic? How does your year of study with us fit into your broader life goals as well as your personal jewish experience and journey? What are your current plans for after program?
*
Scholarships
Aish Passaic has a limited number of need-based scholarships available for applicants for the 2006-2007 school year. It is our belief that no otherwise-eligible student should be denied the opportunity to learn about his Jewish heritage merely because of financial reasons. Tuition at Aish Passaic for the 2006-2007 academic year is $ 13,500
Any requests for scholarships, as well as information provided to the Admissions Committee concerning an applicant's financial need, will be held in the strictest of confidences
FOR ALL NEED-BASED APPLICANTS *I would like to request a need-based scholarship to help me/my family cover the costs of tuition and room and board at Aish during the 2006-2007 academic year. Amount requested is:
FOR APPLICANTS CURRENTLY ENROLLED IN UNIVERSITY: *My parents are currently contributing following amount per year, out-of-pocket, towards my college education:
FOR APPLICANTS CURRENTLY RECEIVING FINANCIAL AID FROM THEIR UNIVERSITY OR A LOAN COMPANY: *I currently receive following amount per year in the form of loans to cover the cost of my college education:
Affirmation I hereby affirm that all of the information I have provided in this application-both personal and financial (if applicable)- is completely true and accurate. I understand that any deliberate falsification of any of the information on this application will result in my expulsion from Aish Passaic.
Attach Photo Of Yourself
Enter Your Name As A Signature *
Enter Current Date: *
