Yeshivat Simchat Shlomo Application Form

Applying to:

q Advanced Women’s Chabura beginning:______________

q Men’s Beit Midrash beginning:______________

q Eco- Activist Beit Midrash beginning:______________

qCommunity Learning Program beginning:______________

All application forms should be accompanied by:

A…Two letters of recommendation

B…Two recent passport size photos

C….Brief essay 200-300 words describing your motivations and goals for applying to Simchat Shlomo

D….If you are applying for financial assistance, please write an essay describing your circumstances and why you should be considered for aide.

Applications should be received no later than August 04, 2010

Questions regarding any portion of the application should be directed to-shulim26@shlomoyeshiva.org

First Name _____________ Middle Name_____________ Last Name_______________

Hebrew Name _______________________________

Current Address _____________________________________________________

Current Telephone Number ____________________ Permanent Telephone __________________________

Email Address _________________________

Permanent Address _________________________________

Emergency Contact Overseas________________________

Emergency Contact in Israel ____________________________________________

Date of Birth___________________

Sex ___ male ___

Passport number ________________

Social Security Number_____________________

Place of Birth _______________

Citizenship ______________________

Occupation/Profession ______________

Mother’s Maiden Name __________________________

Father’s Name___________________

Have you ever been to Israel before? _____yes _____

If yes, when? For how long? In what capacity?

EDUCATION

Please list institutes of education from most recent

From To Institution Degree

Please list institutes of Jewish/Hebrew education from most recent

From To Institution Degree

Please rate your Hebrew skills (Excellent, Very Good, Good or None Yet):

Reading

Reading Comprehension

Speaking

Please list past visits to Israel from most recent

From To Purpose Framework

Please list any special interests, hobbies, awards, volunteer activity etc.

In a brief essay, please describe your motivations and goals in joining us at Simchat Shlomo.