THE MESIVTA/HIGH SCHOOL OF YESHIVAS CHOFETZ CHAIM TALMUDICAL ACADEMY OF BALTIMORE 4445 Old Court Road Baltimore, MD 21208 Tel: (410) 484-6600 EXT. 303 Fax: (443) 725-2059 Email:
[email protected] APPLICATION APPLICATION FOR ADMISSION 1 Date of Application: ___/____/___ Application For Grade: _________ Year Applying For: _____/______ PLEASE ANSWER EVERY QUESTION. PLEASE PRINT. Please have the Educator’s Report filled out and returned to us by your principals. Remittance of a NON-REFUNDABLE application fee of $100.00 is necessary for your application to be processed. Applicant’s Full English Name: ______________________________________________ Applicant’s Full Hebrew Name (in Hebrew): _____________________________________ Name used:___________________________Kohain _____Levi_____Yisroel _________ Date of Birth: ____/____/____ Hebrew Date of Birth: _____________________________ U.S. Citizen Y N Birth Place: ___________________________________ Country Of Citizenship: ____________________________________________________ Social Security #: ___ ___ ___ /___ ____ / ____ ____ ____ ____ Name of School presently attending: _________________________________________ Hebrew Grade _______ Rebbe’s Name___________________ English Grade ________ List all schools previously attended, if any: Name of School Dates of Attendance ______________________________ ________________________________ ______________________________ ________________________________ ______________________________ ________________________________ ______________________________