Midreshet Rachel 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 23) separately before submitting.
–If your essay (question 23) is particularly long, send it separately as an e-mail; the online form takes only a limited number of characters.

Online Application
1. Midreshet Rachel V'Chaya Start Date (required)
Other Start Date (* if you chose other start date, enter a date here)
End date (required)
Other End Date (* If you chose Other end date please enter a date)
Are you interested in living in our dorm, please indicate:(required)
2. Applicant's Name:
Last Name (required)
First Name
Middle
Hebrew
3. Current Address:
Current Street and Number
City
State
ZIP
Telephone #
Cellphone #
Email Address(required)
4. Permanent Address (if not as above):
Permanent Street and Number
City
State
ZIP
Telephone #
Cellphone #
Email Address
5. Personal Information
Birth Date (day/month/year)
Place of Birth
Citizenship
Passport Number (required)
Passport Expiration Date
Were you ever in Israel before?
Dates
Visa Status
Reason for Stay
6. Personal Status
Were you Jewish born?(required)
Converted?(required)
If yes, by which Beit Din?
Adopted?
Were your parents Jewish born?
Mother?
Father?
Mother Converted?
If yes, by which Beit Din?
Adopted?
Father Converted?
If yes, by which Beit Din?
Adopted?
Was your maternal grandmother Jewish born?
Converted?
If yes, by which Beit Din?
Adopted?
Was your paternal grandmother Jewish born?
Converted?
If yes, by which Beit Din?
Adopted?
7. Marital Status
Marital Status (required)
Husband's Name: Last
First
Middle
Hebrew
Husband’s occupation
Date of Marriage
Names & Dates of Birth of Children
8. Parents
Parent’s Marital Status:(required)
if deceased, which parent?
Father’s Name
Place of birth
Father’s Birth Date
Mother’s First & Maiden Name
Place of birth
Mother’s Birth Date
Mother’s Last Name (if not same as father’s)
Father’s address
Home phone
Email Address
Mother’s address (if not same as father’s)
Home phone
Email Address
9. Father’s Occupation
Father’s Occupation
Name of Business
Address & Telephone Number
10. Mother’s Occupation
Mother’s Occupation
Name of Business
Address & Telephone Number
Educational Background
11. Colleges or Universities Attended
Please include school, location, dates, degree, major/minor
School #1
School
Location
Dates
Degree
Major/Minor
School #2
School
Location
Dates
Degree
Major/Minor
School #3
School
Location
Dates
Degree
Major/Minor
12. Torah Education
Please include school, location, dates, curriculum, proficiency
School #1
School
Location
Dates
Curriculum
Proficiency
School #2
School
Location
Dates
Curriculum
Proficiency
School #3
School
Location
Dates
Curriculum
Proficiency
13.Please indicate your proficiency in Hebrew reading and transation: (Please indicate your level by highlighting a number from 1 to 4, where 4 is highest.)
Hebrew Reading
Hebrew Translation
Rashi Reading
Rashi Translation
Spoken Hebrew
Written Hebrew
14. 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.)
15. What are your vocational goals?
16. Activities and organizations in which you have participated, and in what capacity (Hillel, USY, etc.)
16a. Have you ever belonged to NCSY? (required)
17. Hobbies, including artistic skills
18. Medical Information
A. Are you presently undergoing treatment for any illness? (physical or emotional)
Please describe:
B. Do you currently, or have you in the past, suffered from or taken medication for emotional problems?
If yes, please explain:
Are you on any medication for physical problems? If so, what?
Please explain:
19. Do you have any special dietary requirements?
Please describe:
20. Were you interviewed by a member of the Darche Noam staff?
Who?
When?
21. Emergency contacts:
In case of emergency please contact:
A. In Israel, Name
Address
Phone
Relationship
B. In Native Country, Name
Address
Phone
Relationship
22a. How did you hear about us?
Rabbi’s/Rebbetzin’s name
Contact information
Friend’s name
Contact information
Other – name
Contact information
22b. Who is your campus rabbi (if applicable):
23. 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.
Either type directly in this text box below 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.
23a. Photograph - Please attach a photograph of yourself
24. Letters of Recommendation, References
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: mrachel@darchenoam.org Fax to: US fax # 650-412-1469 or Israel fax # 972-2-651-9183 Mail to: Midreshet Rachel v’Chaya College of Jewish Studies for Women P.O. Box 3151, Jerusalem 96343 Israel
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Tuition Fees for the complete academic year 2013-2014 are $9,600. 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.
What color is snow?
Please ensure that your application is fully completed, including photograph, essay, and letter of recommendation. No decision can be made until all materials are received.

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