Application Form

Fill out each item clearly and completely.

  • A personal or telephone interview will be required of all applicants.
  • Kesher reserves the right to request that high school and university transcripts be sent directly to our office.
  • The privilege of studying at Kesher is conditional on satisfactory work and adherence to the rules and regulations of the school. Kesher reserves the right to require the withdrawal of any student, for any reason it deems sufficient.
  • All questions must be answered and application signed and dated to be considered for acceptance.
  • All personal information will be held in strictest confidence.
First Name
Middle Name
Last Name
Hebrew Name ben
Date of Birth
Place of Birth
City
State
Country
Citizenship
Address
Street Address
City, State, Zip
Phone
Emergency Contact (Other than a parent)
Name
Address
Phone
 
Student's Email
Student's Cell Phone
Student's Social Security Number
 
Passport Number
Country
Status in Israel Tourist/Student
Temporary Resident (A1)
Citizen/Oleh    Israeli ID #
Were you ever in Israel before? Yes    No
Do either one of your parents have Israeli citizenship? Yes    No
I am a... Kohen     Levi     Yisrael
Student's Bar Mitzvah Parsha
Were you born of a Jewish mother? Yes   No
How many siblings?
Age range of any siblings
If you, your mother, or her mother were converted, please specify who and fax all available certification to the Kesher office.
Father's Information
Father's Name and Title
Marital Status
Home Address
Occupation
Employer
Home Phone
Cell Phone
Fax
Email
Mothers's Information
Mother's Name (Maiden) and Title
Marital Status
Home Address
Occupation
Employer
Home Phone
Cell Phone
Fax
Email
 
Name of any step-parents
Who does student live with?
Family Congregation
Rabbi
How did you hear about Kesher?
Indicate any special characteristics of your physical health, any allergies?
Have you or are you being treated for any emotional disorders? Please specify:
If you are taking, or took in the past, (on a protracted basis) any medication for any aspect of your health, please indicate:
Did you graduate high school/earn GED?
Organizational affiliations:
If you were not employed since leaving school, describe how you spent this interval:
If employed, since leaving school, who was your last employer?
Name:
Address:
Tel:
Position:
Educational Profile
Schools Attended
Name/Location Dates
Reference #1
Name
Address
Phone
Relationship
Reference #2
Name
Address
Phone
Relationship
A NOTE TO PARENTS:
It is of utmost importance for the kesher staff to work together with you for the success of your son. Please feel free to convey any other information that would help us.

Tuition

  1. NO STUDENT WILL BE ADMITTED WITHOUT REMITTANCE OF TUITION.
  2. To discuss the payment of fees, please contact Mr. Ari Lonner (Israel hours): 054-593-9101 (Mobile) or 718-701-2216 (Evening hours).
  3. All payments are in US dollars.
  4. Credit card payments are available through the Kesher American office.
  5. Checks should be made payable to American Friends of Kesher or Kesher Outreach Organization (Canada).
  6. ALL APPLICANTS MUST SUBMIT COPIES OF THEIR FAMILY'S MOST RECENT TAX RETURNS.
  7. NO TRANSCRIPT OR CREDITS WILL BE ISSUED WITHOUT FULL PAYMENT OF OUTSTANDING FEES. This applies even in the event that deferment of payment while studying has been mutually agreed upon.
  8. ANY STUDENT WHO LEAVES OR IS REMOVED FROM THE PROGRAM WILL BE RESPONSIBLE FOR A FURTHER TWO MONTHS OF TUITION.

Medical Insurance

Medical insurance coverage is mandatory for every student. The cost for the school year is $350.00. This money must be paid upon registration and is non-refundable. Please contact the Kesher office for details.

Visits

Although visits from parents and close family members are welcome, students are expected to continue their regular schedules. No student is allowed to be absent without specific permission from the administration.

Responsibility Waiver Agreement

1. Should the student’s behavior require suspension, the school retains the right to do so. Every student is required to provide a contact in Israel responsible for him during the suspension. The school is not responsible for a student who has been suspended.

Contact Name   Contact Phone #

2. Kesher is exonerated of any loss by theft or otherwise of any personal belongings, for any personal injury incurred off premises or within the premises of Kesher.

I hereby certify that all the information included on this form is true, accurate and complete to the best of my knowledge and that these conditions are to take effect immediately upon the applicant’s acceptance.

Signature       Date: 07/26/17