Application | Mesivta Netzach HaTorah

APPLICANT'S PERSONAL INFORMATION:

Last Name

First Name

Legal Name

Nickname

Full Hebrew Name

Date of Birth

Place of Birth

Home Phone Number

Home Address

City

State

Zip

FAMILY INFORMATION:

Father's Title:

Rabbi Mr. Dr.

Father’s Name:

Mother's Title:

Mrs. Dr.

Mother’s Name:

Marital Status

Married

Divorced

Separated

Widowed

Father’s Occupation

Father’s Email

Father’s Cell

Mother's Occupation

Mother’s Email

Mother’s Cell

Shul/Rabbi:

Will you be applying for Financial Aid?

Yes

OTHER CHILDREN IN FAMILY:

Name

Current School/Grade

Name

Current School/Grade

Name

Current School/Grade

Name

Current School/Grade

Name

Current School/Grade

Name

Current School/Grade

Additional Children (if any):

SCHOOL INFORMATION:

What grade are you applying for?

9th 10th 11th 12th

Current School

Phone Number

Principal

Rebbi

Rebbi's Phone Number

MATERIAL COVERED THIS YEAR:

הלכה

נביאים

תורה

גמרא

Is applicant presently enrolled in any Regents course?

Yes

Has applicant ever been evaluated or have an IEP report?

Yes

Does applicant have a 504 accommodation?

Yes

If the applicant has attended other schools, please list them below:

Name of School:

School Phone Number

Grades Attended:

Name of School:

School Phone Number

Grades Attended:

Name of School:

School Phone Number

Grades Attended:

INTERESTS:

Which subjects do you enjoy most?

List Scholastic prizes, honors, or contests won:

Where did you spend the last two summers?

Please note any talents/interests and additional information:

Does your son have any known allergies

Yes

If Yes, please list them here:

All applicants must take a written examination. Exam should take approximately one hour.

This written exam will be offered in the Mesivta on the following days:

Dates - TBA

You must call to Mesivta to make an appointment.

Additionally, every applicant must take a Farher, for which he should prepare an Amud of Gemara with Rashi and 1 Tosefos. Upon completion of application, you will be redirected to select your Farher slot.

Please note, applications can not be processed until all of the following is completed:

- Completed application

- Non-refundable application fee of $100.00

- Completion of written exam and oral Farher

The Mesivta's receipt of:

- 7th Grade report Card (attach below) as well as 8th Grade Report Card when available

- Principals' Evaluation and school transcripts have been received by the Mesivta office. Please click here to download form, and submit to your Menahel/Principal.

Please upload your most recent report cards. If you are unable to attain your son's report cards at this time, please complete the application and send the office the report cards as soon as possible. The application is not complete until all requested documents have been submitted.

Hebrew Report Card Upload

English Report Card Upload

Student Photo Upload

Please be aware, the Mesivta has limited spots for families outside the Five Towns/Far Rockaway community.

Please call the Mesivta to schedule a fahrer

We hereby certify that the information given in this application is complete and accurate.

Date

Electronic Signature of Applicant:

Electronic Signature of Father:

Electronic Signature of Mother:

APPLICATION FEE

Credit Card Number

Exp. Date

CVV

Name On Card

Billing Street Address

Billing City

Billing State

Billing Zip

If you are using an international card, please enter 11111 as the zipcode

2022-2023 School Year Application

APPLICANT'S PERSONAL INFORMATION:

FAMILY INFORMATION:

OTHER CHILDREN IN FAMILY:

SCHOOL INFORMATION:

INTERESTS:

We hereby certify that the information given in this application is complete and accurate.

APPLICATION FEE

Mesivta Netzach HaTorah