Application Form -- Darche Noam Institutions

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Darche Noam/Shapell's Application Form

Instructions:
All applications must be filled out in full. On completion, please submit this form (by clicking on the submit button at the bottom of the page), and send us two letters of recommendation and a digital photograph to our Israel office.

Please read this first to ensure a successful application:
--The form might not work for older browsers, but you can print out the form, fill it in, and fax or mail it to the Darche Noam Israel office.
--If you want to cut and paste the form to a word processing program and send it to us as an attached file, please do not type the answers into the text boxes. It becomes difficult to process the application.
--It is probably a good idea to save your essay (question 12) separately before submitting.
--If your essay (question 12) is particularly long, send it separately as an e-mail; the online form takes only a limited number of characters.

Application for admission for semester beginning
Planned Length of studies

1. Applicant's Name:

Last

First

Middle

Hebrew

Wife's Name:

Wife's Last Name

First

Maiden

Hebrew

2. Current Address:

Street and Number

City

State

ZIP

Telephone #

Cellphone #

Email Address

3. Permanent Address (if not as above):

Street and Number

City

State

ZIP

Telephone #

Cellphone #

Email Address

4. Personal Information

Birth Date (day/month/year)

Place of Birth

Citizenship

Passport #

Expires

Social Security Number

Were you ever in Israel before?

Dates

Visa Status

Reason for Stay

5. Personal Status

Are there any conversions or adoptions in your family history?

Yes
No

If yes, please provide details.

6. Marital Status

Marital Status

Wife's Name

Date of Marriage

Names & Dates of Birth of Children

7. Parents:

Parent's Marital Status:

Father's Name

Place of Birth

Mother's First & Maiden Name

Mother's Last Name
(if not same as father's)

Place of birth

Father's address

Home phone

Email Address

Mother's address

Home phone

Email Address

Father's Occupation

Name of Business

Address & Telephone Number

Mother's Occupation

Name of Business

Address & Telephone Number

8. Educational Background

Colleges or Universities Attended

School Location Dates Degree Major/Minor

Torah Education

School Location Dates Curriculum Proficiency

9. Essay
Please write an essay (the equivalent of one or two pages) describing: your religious background and present commitment; discuss any books (secular or religious) which have had an impact on you; extent of your Jewish studies and textual skills in various Jewish subjects (Talmud, Chumash, etc.); why you feel Darche Noam/Shapell's is appropriate for you.
Either type directly in this text box or send it as an attached file.
To avoid accidentally losing your essay please save it in a separate file on your computer before submitting.
--If your essay is particularly long, send it separately as an e-mail; the online form takes only a limited number of characters.

10. Background and Interests:

My knowledge of Hebrew is:

Reading

Writing

Speaking

Understanding

If time has elapsed since you last attended school, describe how that time has been spent (if you've been employed please give name of company or employer.)

What are your vocational goals?

Activities and organizations in which you have participated, and in what capacity

Hobbies, including artistic skills

Medical Information
Do you have any medical conditions or physical disabilities?
Please describe:

11. Letters of Recommendation, References
Please forward two letters of recommendation, at least one of which is from a rabbi or Jewish educator who has known you for a period of at least one year.

Please ask those who write letters of recommendation to include:
a. the name of the organization they represent; and
b. an address and phone number for any follow-up questions.

Send in one of the following ways:

E-mail to: shapells@darchenoam.org
Fax to: US fax # 516-908-6020 or Israel fax # 972-2-652-0801
Mail to:

Yeshivat Darche Noam/David Shapell College of Jewish Studies
POB 3151
Jerusalem, 96343
Israel

Were you interviewed by a member of the Darche Noam staff?
Who? When?

12. Emergency contacts:

In case of emergency please contact:

In Israel, Name

Address

Phone

Relationship

In Native Country, Name

Address

Phone

Relationship

All inclusive fees for the Darche Noam/Shapell College full time programs for 2007/8 are US $13,350. This amount includes a $400 non-refundable registration fee due upon acceptance, the activities fee, tuition, room and board. These fees comprise all fees for the first eight months of study. The following four consecutive months are included in these fees at no additional cost. Prorated refunds will be given (minus the non-refundable registration fee) for students who withdraw within eight months of enrollment. One month advance notice is required. If financial assistance is required, please contact us at: shapells@darchenoam.org

The applicant agrees to abide by the rules and regulations set by Darche Noam for the health, safety and welfare of the students.

I understand that Darche Noam/Shapell's, while it takes precautions to eliminate the risk of loss or damage to applicant's personal property, is not held financially responsible if such loss or damage should occur.

I certify that the information given in this application is complete and correct.

Signature of Applicant
Date

Please ensure that your application is fully completed, including a digital photograph, essay, and 2 letters of recommendation. No decision can be made until all materials are received.

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