Darche Noam/Shapell's Application Form
Please indicate when you want to start learning at Shapell's and until when you want to continue:
Last
First
Middle
Hebrew
Wife's Last Name
Maiden
Street and Number
City
State
ZIP
Telephone #
Cellphone #
Email Address
Birth Date (day/month/year)
Place of Birth
Citizenship
Passport Number
Passport Expiration Date
Were you ever in Israel before?
Dates
Visa Status
Reason for Stay
Yes No
8. Parents:
Father's Name
Father's Birth Date
Mother's First & Maiden Name
Mother's Birth Date
Place of birth
Father's address
Home phone
Mother's address
Father's Occupation
Name of Business
Address & Telephone Number
Mother's Occupation
11. 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
Are you presently undergoing treatment or taking medication for any illness or condition (physical or emotional) not described above?
If yes, please explain:
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?
13. Emergency contacts:
In case of emergency please contact:
In Israel, Name
Address
Phone
Relationship
In Native Country, Name
All inclusive fees for the Darche Noam/Shapell College full time programs for 2010/11 are US $15,500. 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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