United Lubavitcher Yeshiva Ocean Parkway Preschool Application Form

Home , Ocean Parkway (Brooklyn)

בס"ד United Lubavitcher Yeshiva Ocean Parkway Preschool Application Form

Students Info:

Student’s Legal Name ______Home Address: ______

Hebrew Spelling of Name: ______City: ______

Name child goes by: ______State: ______

Hebrew Date of Birth: ______Zip: ______

English Date of Birth: ______Home Phone: ______

Please provide 2 family references:

Name: ______Cell: ______

Parents Info:

Mother’s Name: ______Father’s Name: ______

Country of Birth ______Country of Birth ______

Occupation ______Occupation ______

Work Phone ______Work Phone ______

Cell Phone ______Cell Phone ______

Email Address ______Email Address ______

Maternal Grandparents Name ______Paternal Grandparents Name ______

Grandparents Address ______Grandparents Address ______

841 Ocean Parkway Brooklyn N.Y. 718 859 7600 www.ULYOP.com בס"ד United Lubavitcher Yeshiva Ocean Parkway Preschool Application Form

Child’s parents is/are:  Married  Separated  Divorced  Father deceased  Mother deceased.

Does the child have Shul affiliated with: ______any allergies? ______

Language(s) spoken Is your child fully at home: ______immunized? ______

How did you hear about our preschool? ______

Program child is currently attending: ______

Contact person ______Phone number: ______

Do you give us permission to contact them? Yes / No

Siblings-grade(s) and school(s) attending:

Name Grade School

841 Ocean Parkway Brooklyn N.Y. 718 859 7600 www.ULYOP.com בס"ד United Lubavitcher Yeshiva Ocean Parkway Preschool Application Form

Are there any physical disabilities or medical conditions that require accommodations or services?

Please Explain ______

______

Has your child ever had a district or private evaluation? YES NO

Is your child currently receiving any district support services? YES NO (i.e.. Speech therapy, occupational therapy, physical therapy, counseling, SEIT)

If yes, please specify? ______

If yes, please email the most recent evaluations/IEP.

Please comment on your child’s social and emotional development (i.e. outgoing, shy, assertive, unusually active): ______

______

Is there any additional information you would like to share with us to assist us in better understanding your child? (child development, family life etc.) ______

______

Please email a family photo and a recent photograph of your child with your application

841 Ocean Parkway Brooklyn N.Y. 718 859 7600 www.ULYOP.com בס"ד United Lubavitcher Yeshiva Ocean Parkway Preschool Application Form

Please Note:

Tuition is $8,500 a year.

Financial Aid: Will you be applying for financial aid? Yes / No (Acceptance will not be determined based on financial need)

Signature: ______

Date: ______

841 Ocean Parkway Brooklyn N.Y. 718 859 7600 www.ULYOP.com