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Application Form
First Name
Last Name
Email
Home Address
Telephone No. in Israel (no spaces or () or - )
Home Telephone (no spaces or () or - )
Date of Birth dd/mm/yy
Place of birth
Nationality/s
Marital Status
No. of children
Father's Name
Father's Occupation
Mother's Name
Mother's occupation
Education (Jewish & Secular) and work ( from age 15)
Knowledge of Hebrew ( Reading & Speaking)
Extra-curricular interests and activities
Reasons for wishing to attend the Academy
Medical Insurance
Present Doctor ( Name, Address, & Tel. no.)
Relative in Israel: Name:
Relative's Relationship
Relative's Address
Relative's Tel. No.
Period you wish to attend ( from: to:)
Do you request dorm?
I agree to pay:
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Date application Submitted( dd/mm/yy) :
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