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שאל את הרב
שאלון לתלמיד
Application Form
Application Form
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Name
*
First
Last
Home Address
Email
*
Home Telephone Number
Israel Telephone Number
Cell Phone Number
Date of Birth Day/Month/Year
Place of Birth
Nationality
Passport Number
Country of Issue of Passport
Teudat Oleh Number
Teudat Zehut Number - Send Photo of Teudat Zehut or Passport to dvar@dvar.org.il
Marital Status & Number of Children
Father's Name & His Occupation
Mother's Name & Her Occupation
Education (Jewish & Secular) and Work (from age 15)
Reference of Teacher / Rabbi
Reasons for wishing to attend the Academy
Knowledge of Hebrew , Reading / Writing
Extra-curricular interests and activities
Medical Insurance
Present Doctor (Name, Address & Tel. No.)
Period You Wish To Attend From: ____ To:____
Relative in Israel: Name / Address / Tel. No. / Relationship
Do You Request Dorm?
Yes
No
Undecided
Amount of Tuition I agree to pay
Today's Date
Comment
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