Admittance Application - The Rohr Bais Chaya Academy

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	Admittance Application

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Admittance Application
Please find a link on the left hand side to pay the registration fee.

Email Address
Email Must* be filled in for application to be sent!
Date of application:
Request for admittance for school year:
Grade Entering
High School Grade* Must be filled in for application to be sent
Social Security Number

Student Information:

Is the applicant adopted?	Yes No
Were both parents born into the Jewish Faith?	Yes No
Were all grandparents born into Jewish Faith?	Yes No
Physical handicaps?	Yes No
If yes, explain:
Any serious illnesses?	Yes No
If yes, explain:
Is the applicant currently on any maintenance medication?	Yes No
If yes, explain

ADDITIONAL FAMILY INFORMATION:

Father's Name:
Father's Hebrew Name:
Home address (if different from student)
Occupation:
Job Title:
Employer:

Phone:
Cell:
Email
Business Name
Business Address:
Work Number:

Mother Name:
Mother Hebrew Name:
Home address (if different from student)
Occupation:
Job Title:
Employer:

Phone:
Cell:
Email
Business Name
Business Address:
Work Number:

Contact Data:

Please indicate name(s) of person(s) and address(es) who should receive report cards if different from above:
Are Parents Married?	Yes No
Separated ?	Yes No
Divorced?	Yes No
If yes, who has legal custody?
With whom does the student live?

BACKGROUND EDUCATION INFORMATION

List names and dates of schools attended from preschool to present including Talmud Torah attendance:

Has the student ever been dismissed from any school?	Yes No
If yes, explain
Indicate briefly the extent of student's education by subject studied: (indicate the language in which they were studied: Hebrew, English, Yiddish).
Favorite subject:
Most difficult subject:
List scholarships, prizes, contests or other awards:
List extra-curricular activities: (Athletics, Music, School Publications, etc.)
List organization memberships:
ESSAY - Please enclose a 500 word essay. Topic: Why I wish to attend THE ROHR BAIS CHAYA ACADEMY

The Rohr Bais Chaya Academy • 8100 N University Drive • Tamarac, FL 33321-1717 • 954-788-8781