Yeshiva Application

This application must be completed in full by candidates seeking to enroll at  Ohr Somayach Monsey for long term learning. All information will be considered confidential. For any further questions, please do not hesitate to contact our office.

Required fields:*


Personal Information:
First Name:*
Last Name:*
Hebrew Name:* (You may type your Hebrew name in English Characters)
Legal Address:*
City, State/Province, Zip:* , ,
Country:*
E-mail Address:*
Mailing Address:
(if different)
Mailing City, State/Province, Zip:
(if different)
, ,
Country:*
Phone Number:*
Emergency Contact:
Contact Name:*
Phone Number:*
Relationship:*
Recent Picture:* (Valid format: JPG up to 4 MB)

Legal Information:
Citizenship:*
Date of Birth:* ,
Place of Birth:*
Social Security Number:* - -
If not U.S Citizen, Passport No:
Passport Date of Expiration: ,
Visa No:
Visa Date of Expiration: ,

Occupation Information:
Occupation:

Work
School
Other

     If Working, List Employer: *
     Business Address: *
     Business City, State/Province Zip: , , *
     Country: *
     Business Telephone: *
     Annual Salary: *
   
     If "Other" Selected Above,
     Please Describe:
*

Spouse Information:
Marital Status:*

Single
Married
Divorced
Separated
Widowed

Spouse Name:
 First:    Maiden:
Spouse's Occupation:

Parent Information:
Parents Are:*

Married
Divorced
Separated
Deceased

Father‘s Name:*
Father‘s Telephone Number:*
Father‘s Address:*
Father's City, State/Province, Zip:* , ,
Country:*
Father‘s Occupation:*

Mother’s Name:*
Mother’s Maiden Name:*
Mother‘s Telephone No*
Mother‘s Address:*
Mother's City, State/Province, Zip:* , ,
Country:*
Mother‘s Occupation:*

Family Information:
Other children in family:* Yes
No
Number of Brothers:
Number of Sisters:
Was your father born Jewish?* Yes
No
Was your mother born Jewish?* Yes
No
Have you ever undergone a conversion?* Yes
No
If yes, under whose auspices?
Are you ashkenaz or sephardic?* Ashkenaz
Sephardic
Are you the child of a second marriage (or more) of either parent?* Yes
No
Are you the oldest in your family?* Yes
No

Education:
(List chronologically all the schools you have attended)
Secondary School Name:
Secondary School Location:
Dates of Attendance?
From ,
To ,
Graduation Date or Expected Graduation Date:

,


College/University Name:
College/University Location:
Dates of Attendance?
From ,
To ,
Graduation Date or Expected Graduation Date:

,


Jewish School Name:
Jewish School Location:
Dates of Attendance?
From ,
To ,
Graduation Date or Expected Graduation Date:

,


Educational Information:
Jewish Education: *
Read: *
Write: *
Speak: *
Fluent:*
Have you ever attended a
Legacy Retreat?
Yes
No
If some time has elapsed since you last attended school, tell how you have spent this time:
Scholarships, prizes, or other awards received:
Activities and organizations in which you have participated:
Students are required to present a copy of a H.S. diploma or a copy of the most recent academic record.

Personal Information:
How did you hear of Ohr Somayach?*
Have you ever attended Ohr Somayach?* Yes
No
If yes, please describe:
Why do you wish to attend Ohr Somayach?*
The cost of annual tuition room and board is $18,000.
If you need financial assistance please call the office at 845 425-1370 to discuss scholarship availability.
List all previous financial aid which you have received through other universities.
Do you have any known medical conditions? * Yes
No
If yes, please explain:
Have you ever been through professional counseling?* Yes
No
If yes, when and for what:
Every student on campus must submit a record of immunizations no student is allowed to reside on campus prior to submitting their immunization records.

Personal References:
(Please list two)
Name:*
Address:*
City, State/Province, Zip:* , ,
Country:*
Phone:*

Name:*
Address:*
City, State/Province, Zip:* , ,
Country:*
Phone:*

Expected Length of Stay at Ohr Somayach Monsey:
From Date:*
To Date:*

Captcha:
Enter the code in the text box:*
(This prevents spam in the form)

Code

I understand that upon acceptance the following must be submitted either by email or fax:

(No student will be allowed to reside on campus prior to submitting their immunization record.)



I hereby apply for enrollment as a regular student at Ohr Somayach Tanenbaum Educational Center, registering in a program which leads to a First Talmudic Degree/First Professional Degree. I certify that all the information contained on this application is accurate and complete to the best of my knowledge. I further understand that I must remain in compliance of all the rules and regulations as described in catalog and other official notices and publications.


Record of immunizations are required at time of admission.
Please either: e-mail to ohr@os.edu, fax -845 425-8865, or bring documentation upon arrival



 
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