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Midreshet Rachel v'Chaya Application Form

I wish to learn from (month/year)
Until (month/year) .
If you are interested in living in our dorm, please indicate:

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 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 as a MS Word document or as a PDF file, fill it in, and fax or mail it to the Midreshet Rachel v'Chaya Israel office.
    --Please do not cut and paste this form to a word processing program and send it to us as an attached file. It becomes difficult to process the application.
    --It is probably a good idea to save your essay (question 11) separately before submitting.
    --If your essay (question 11) is particularly long, send it separately as an e-mail; the online form takes only a limited number of characters.

    Applicant's Name
    Last
    First
    Middle
    Hebrew
       
    Address for Correspondence
    Street and Number
    City
    State
    Zip Code
    Country
    Telephone #
    Cellphone #
    Fax #
    Email Address
    		 
    Permanent Address
    Give the name and address of a person through whom you can always be reached when not at your correspondence address. Write “same” if both addresses are the same.
    Street and Number
    City
    State
    Zip Code
    Country
    Telephone #
    Fax #
    Email Address
       
    Applicant's occupation/field of study:
    Name of business or institution / tel. #
    Birth Date
    Day/Month (please write it out)/Year
    Place of Birth
    Citizenship
    :
    Passport Information, Visits to Israel
    Passport # or Israel Identification #.
    Expires
    Type of Visa
    Previous Vists to Israel: Purpose of trip
    Dates
    		 
    Synagogue
    Synagogue you attend
    Rabbi
    Rabbi's address
    Rabbi's telephone

    Family
    Father's Full Name (first/last)
    City and country of Birth
    Mother's First & Maiden Name (first/last)
    City and country of Birth
    Mother's Last Name (if not the same as father's)
    Parents' Marital Status
    Father's Address
    Father's Telephone Number
    Mother's Address
    Mother's Telephone Number
    Father's Occupation
    Name of Business
    Address & Telephone #
    Mother's Occupation
    Name of Business
    Address & Telephone #
    Husband's Name: Last
    First
    Middle
    Hebrew
    Husband's occupation
    Children's names and ages
    Were you Jewish born?
    		 Yes No
    Converted?
    		 Yes No
    If yes, by which Beit Din?
    Adopted?
    		 Yes No
    Were your parents Jewish born?
    		 Yes No
    Mother?
    		 Yes No
    Father?
    		 Yes No
    Mother Converted?
    		Yes No
    If yes, by which Beit Din?
    Adopted?
    		 Yes No
    Father Converted?
    		Yes No
    If yes, by which Beit Din?
    Adopted?
    		 Yes No
    Were your grandmothers Jewish born?
    		 Yes No
    Maternal grandmother
    		  
    Converted?
    		Yes No
    If yes, by which Beit Din?
    Adopted?
    		 Yes No
    Paternal grandmother
    		  
    Converted?
    		Yes No
    If yes, by which Beit Din?
    Adopted?
    		 Yes No
     
    Educational Background
    Colleges or Universities Attended
    Name of School / Location/Years Attended/Degree/Major & Minor/ Graduation Date
     
    Torah Education
    Name of School / Location / Years Attended / Subjects
    Proficiency in Hebrew is (Rate from 1 to 4, where 4 is highest.)
    Hebrew Reading    
    Hebrew Translating
    Rashi Reading
    Rashi Translating
    (Rate the following either "good", "fair", "poor", or "none".)
    Hebrew Writing    
    Hebrew Speaking    

    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:

    Are you presently undergoing treatment for any illness? (physical or emotional)
    Please explain:

    Do you currently, or have you in the past, suffered from or taken medication for emotional problems? If so, please explain.
    Are you on any medication for physical problems? If so, what? Please explain.

    Interviewed by a staff member?
    Interviewer's name:
    Date of interview:

     
    If possible, please give the name of a person in Israel who can be a reference for you.
    Name
    Address
    Tel
    In case of emergency, the following people should be contacted:
    In Israel, Name
    Address
    Phone
    Relationship
    In Native Country, Name
    Address
    Phone
    Relationship
    		 
    How did you hear about us?
    Rabbi/Rebbetzin's name
    Contact information
    Friend's name
    Contact information
    Other - name
    Contact information

    Essay
     Please write a one to two page essay describing your religious background and present commitment to Judaism, extent of your Jewish studies and textual skills in various Jewish subjects; your reasons for wanting to study at this time and why you feel MRC is appropriate for you. Discuss any books or people (secular or religious) which have had an impact on you and why.
    Please save your essay in a separate file before submitting.
    If your essay is particularly long, send it separately as an e-mail or as an attached file.

    Letters of Recommendation
         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 about one year. Send it to us in one of the following ways:

    E-mail to: mrachel@netvision.net.il
    Fax to: 972-2-651-9183 or 1-501-641-0817
    Mail to:

    Midreshet Rachel v'Chaya College of Jewish Studies for Women
     P.O. Box 3151,
    Jerusalem 96343
    Israel

    Tuition Fees for the complete academic year 2007-2008 are $9,200. This includes a non-refundable fee of $250 for registration and $350 for student activities. This $600 is due upon acceptance. Financial assistance may be available from your local synagogue, MASA Program, JCC, Federation, and/or Hillel. If further financial assistance is required, please request a financial assistance application form.

    I agree to abide by the rules and regulations set by Midreshet Rachel v’Chaya for the health, safety, and welfare of the students. I understand that Midreshet Rachel v’Chaya, 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 two letters of recommendation. No decision can be made until all materials are received.

     

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