- Shapell's/Darche Noam

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 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. Semester
Darche Noam/Shapell's Start Date:(required)
End Date(required)
Other start date (*If you chose Other start date, enter a date here)
Other end date (*If you chose Other end date, enter a date here)
2. Applicant's Name:
Last Name (required)
First Name(required)
Middle
Hebrew
Wife’s Name:
Wife’s Last Name
First
Maiden
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
Are there any conversions or adoptions in your family history?(required)
if yes, please describe
7. Marital Status
Marital Status (required)
Wife’s Name
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. My knowledge of Hebrew is:
Reading
Writing
Speaking
Understanding
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
17. Hobbies, including artistic skills
18. Medical Information
A. Do you have any medical conditions or physical disabilities?
Please describe
B. Are you presently undergoing treatment or taking medication for any illness or condition (physical or emotional) not described above?
If yes, 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
22. How did you hear about us?
Rabbi’s name
Contact information
Friend’s name
Contact information
Other – name
Contact information
23. Essay
Please write an essay (the equivalent of one or two pages) describing: your feelings toward Judaism and present commitment; any books (secular or religious) and experiences which have had an impact on you and why; any plans you have to study in Israel in the future.
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.
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: 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
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All inclusive fees for the Darche Noam/Shapell College full time programs for 2011/12 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
Ten minus five equals
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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