The Hebrew Academy

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Prospective Parent Application

Page 1 of 4

Prospective Family Preliminary Application Form
  1. How many legal Guardians are there in this household*
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  2. How Many Students are you enrolling*
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  3.  
  1. Parent/Legal Guardian #1
  2. Title*
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  3. First Name*
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  4. Last name*
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  5. Hebrew Name*
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  6. Have there been any conversions or adoptions in the family?*
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  7. Who?*
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  8. Address*
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  9. City*
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  10. State*
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  11. Zip Code*
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  12. Home Phone*
    Please enter a Valid Phone Number
  13. Cell Phone
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  14. Work Phone
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  15. Email*
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  16. Occupation*
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  17. Marital Status*
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  18. Synagogue Affiliations*
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  19. Relationship to Student*
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  20. Parent/Legal Guardian #2
  21. Title*
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  22. Last Name*
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  23. First Name*
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  24. Hebrew Name*
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  25. Have there been any conversions or adoptions in the family?*
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  26. Who?*
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  27. Address*
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  28. City*
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  29. Sate*
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  30. Zip Code*
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  31. Home Phone*
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  32. Cell Phone
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  33. Work Phone
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  34. Email*
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  35. Occupation*
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  36. Marital Status*
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  37. Synagogue Affiliations*
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  38. Relationship to Student*
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  39.  
  1. Child #1
  2. First Name*
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  3. Last Name*
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  4. Hebrew Name*
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  5. Gender*
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  6. Birthdate*
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  7. Grade Entering*
    Please select an option from the list
  8. School District*
    Please select an option from the list
  9. *
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  10. Child lives with*
    please select an option from the list
  11. Who?*
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  12. Who has legal custody?*
    Please select an option from the list
  13. Who?*
    Invalid Input
  14. Is non-custodial parent legally entitled to receive copies of school reports?*
    Invalid Input
  15. Is non-custodial parent legally entitled to pick up child from school?*
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  16. Who has financial responsibility for this applicant?*
    Please select an option from the list
  17. Who?*
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  18. Present School*
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  19. Contact Name*
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  20. School Phone*
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  21. School Address*
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  22. City*
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  23. State*
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  24. Zip Code*
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  25. Date Attended*
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  26. Grades Finished or in Progress*
    Please select an option from the list
  27. Approximate Grade of Judaic Studies*
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  28. Approximate Grade of Secular Studies*
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  29. Has your child been evaluated for concerns regarding
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    If yes, please provide a copy of the assessment to the school office.
  30. How would you describe your child's personality and/or behavioral characteristics?*
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  31. What are your child's greatest strengths and weaknesses?*
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  32. Describe your child's learning style (verbal, auditory, visual, kinesthetic) and the way he/she learns best?*
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  33. How would you describe your child's academic performance/school experience to date?*
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  34. Tell us about any special interests/talent in Music, Art, Religion, Athletics, Academics that you child has:*
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  35. Please share with us some of the reasons you feel The Hebrew Academy would be a desirable environment for your child and family.*
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  36. What are your educational expectations of The Hebrew Academy?*
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  37. Does your child have any academic, physical, psychological or emotional issues that may require special accommodations by the school?*
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  38. Child #2
  39. First Name*
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  40. Last Name*
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  41. Hebrew Name*
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  42. Gender*
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  43. Birthdate*
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  44. Grade Entering*
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  45. School District*
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  46. *
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  47. Child lives with*
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  48. Who?*
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  49. Who has legal custody?*
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  50. Who?*
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  51. Is non-custodial parent legally entitled to receive copies of school reports?*
    Invalid Input
  52. Is non-custodial parent legally entitled to pick up child from school?*
    Invalid Input
  53. Who has financial responsibility for this applicant?*
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  54. Who?*
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  55. Present School*
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  56. Contact Name*
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  57. School Phone*
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  58. School Address*
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  59. City*
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  60. State*
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  61. Zip Code*
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  62. Date Attended*
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  63. Grades Finished or in Progress*
    Invalid Input
  64. Approximate Grade of Judaic Studies*
    Invalid Input
  65. Approximate Grade of Secular Studies*
    Invalid Input
  66. Has your child been evaluated for concerns regarding
    Invalid Input
    If yes, please provide a copy of the assessment to the school office.
  67. How would you describe your child's personality and/or behavioral characteristics?*
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  68. What are your child's greatest strengths and weaknesses?*
    Invalid Input
  69. Describe your child's learning style (verbal, auditory, visual, kinesthetic) and the way he/she learns best?*
    Invalid Input
  70. How would you describe your child's academic performance/school experience to date?*
    Invalid Input
  71. Tell us about any special interests/talent in Music, Art, Religion, Athletics, Academics that you child has:*
    Invalid Input
  72. Please share with us some of the reasons you feel The Hebrew Academy would be a desirable environment for your child and family.*
    Invalid Input
  73. What are your educational expectations of The Hebrew Academy?*
    Invalid Input
  74. Does your child have any academic, physical, psychological or emotional issues that may require special accommodations by the school?*
    Invalid Input
  75. Child #3
  76. First Name*
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  77. Last Name*
    Invalid Input
  78. Hebrew Name*
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  79. Gender*
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  80. Birthdate*
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  81. Grade Entering*
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  82. School District*
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  83. *
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  84. Child lives with*
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  85. Who?*
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  86. Who has legal custody?*
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  87. Who?*
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  88. Is non-custodial parent legally entitled to receive copies of school reports?*
    Invalid Input
  89. Is non-custodial parent legally entitled to pick up child from school?*
    Invalid Input
  90. Who has financial responsibility for this applicant?*
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  91. Who?*
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  92. Present School*
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  93. Contact Name*
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  94. School Phone*
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  95. School Address*
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  96. City*
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  97. State*
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  98. Zip Code*
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  99. Date Attended*
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  100. Grades Finished or in Progress*
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  101. Approximate Grade of Judaic Studies*
    Invalid Input
  102. Approximate Grade of Secular Studies*
    Invalid Input
  103. Has your child been evaluated for concerns regarding
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    If yes, please provide a copy of the assessment to the school office.
  104. How would you describe your child's personality and/or behavioral characteristics?*
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  105. What are your child's greatest strengths and weaknesses?*
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  106. Describe your child's learning style (verbal, auditory, visual, kinesthetic) and the way he/she learns best?*
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  107. How would you describe your child's academic performance/school experience to date?*
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  108. Tell us about any special interests/talent in Music, Art, Religion, Athletics, Academics that you child has:*
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  109. Please share with us some of the reasons you feel The Hebrew Academy would be a desirable environment for your child and family.*
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  110. What are your educational expectations of The Hebrew Academy?*
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  111. Does your child have any academic, physical, psychological or emotional issues that may require special accommodations by the school?*
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  112. Child #4
  113. First Name*
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  114. Last Name*
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  115. Hebrew Name*
    Invalid Input
  116. Gender*
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  117. Birthdate*
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  118. Grade Entering*
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  119. School District*
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  120. *
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  121. Child lives with*
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  122. Who?*
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  123. Who has legal custody?*
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  124. Who?*
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  125. Is non-custodial parent legally entitled to receive copies of school reports?*
    Invalid Input
  126. Is non-custodial parent legally entitled to pick up child from school?*
    Invalid Input
  127. Who has financial responsibility for this applicant?*
    Invalid Input
  128. Who?*
    Invalid Input
  129. Present School*
    Invalid Input
  130. Contact Name*
    Invalid Input
  131. School Phone*
    Invalid Input
  132. School Address*
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  133. City*
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  134. State*
    Invalid Input
  135. Zip Code*
    Invalid Input
  136. Date Attended*
    Invalid Input
  137. Grades Finished or in Progress*
    Invalid Input
  138. Approximate Grade of Judaic Studies*
    Invalid Input
  139. Approximate Grade of Secular Studies*
    Invalid Input
  140. Has your child been evaluated for concerns regarding
    Invalid Input
    If yes, please provide a copy of the assessment to the school office.
  141. How would you describe your child's personality and/or behavioral characteristics?*
    Invalid Input
  142. What are your child's greatest strengths and weaknesses?*
    Invalid Input
  143. Describe your child's learning style (verbal, auditory, visual, kinesthetic) and the way he/she learns best?*
    Invalid Input
  144. How would you describe your child's academic performance/school experience to date?*
    Invalid Input
  145. Tell us about any special interests/talent in Music, Art, Religion, Athletics, Academics that you child has:*
    Invalid Input
  146. Please share with us some of the reasons you feel The Hebrew Academy would be a desirable environment for your child and family.*
    Invalid Input
  147. What are your educational expectations of The Hebrew Academy?*
    Invalid Input
  148. Does your child have any academic, physical, psychological or emotional issues that may require special accommodations by the school?*
    Invalid Input
  149.  
  1. How did you hear about The Hebrew Academy?*
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  2. Family Name*
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  3. How?*
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  4. Payment Options*
    It is required and may not be left blank

    Please note: Your application is not complete until we have received your registration fees.

    If you select Credit Card, you will have the opportunity to pay when you submit this form. If you select Check or Cash, please send your payment to The Hebrew Academy, 315 N. Main Street, New City, NY, 10956 Attn: Admissions.




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  6. Please check the box in lieu of a Signature *
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  7. Please check the box in lieu of a Signature *
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  8. Submit
      

© 2013 The Hebrew Academy
315 N. Main Street    New City, NY 10956
Phone: 845-634-0951 Fax: 845-634-7704