Apply

Thank you for your interest in Bais Yaakov Ateres Miriam

Please submit your complete application. Additional paperwork may need to be submitted, such as school transcripts and teacher recommendations. Likewise, please schedule a time for a student/family interview with our menahel.
If you have any questions, please let us know by emailing Mrs. Rivki Horowitz at rhorowitz@baisyaakovam.org.

Applicant

Please upload an image of the applicant

First Name

Middle Name

Last Name

Full Hebrew Name in Hebrew Letters

Preferred Name

Applying To Grade

Date of Birth

First/Primary Language

Languages Spoken at Home

Shul Affiliation

Name of Rav

Referred by Existing Family

Additional Referral Notes

Why are you interested in attending Bais Yaakov Ateres Miriam?

Parents' Marital Status

Family

Home Phone Number

Address

City

State

Zip

Special family circumstances

Mother's Information

Deceased

Title

First Name

Middle Name

Last Name

Maiden Name

Hebrew Name

Father's Information

Deceased

Title

First Name

Middle Name

Last Name

Hebrew Name

Siblings

First Name

Middle Name

Last Name

Date of Birth

Age

Current School

Grade

Gender

Add More

Relatives

Please list any relatives who are currently or who have previously attended our school. If none, please leave blank.

Name

Maiden Name

Relationship to applicant

Last Year Attended

Graduation Year

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Grandparents

Please enter both maternal and paternal Grandparent(s) AND Great-Grandparent(s) ka"h, one at a time. We want to share nachas with them so please be sure to include as much information as you can. Thank you!

Relationship

Last Name

Grandfather's Title

Grandfather's Name

His Cell

His Email

Grandmother's Title

Grandmother's Name

Her Cell

Her Email

Home Phone Number

Address

City

State

Zip

Relationship

Last Name

Grandfather's Title

Grandfather's Name

His Cell

His Email

Grandmother's Title

Grandmother's Name

Her Cell

Her Email

Home Phone Number

Address

City

State

Zip

Add More

Medical Information

Please upload a current immunization record as provided by the student's pediatrician.

Immunization Form

Choose file

Medical Conditions and/or Severe Allergies

Is your child currently taking any medications?

Are there any severe allergies the school should be aware of?

Is there any additional information you would like to include with this application? If yes, please do so here.

Current School

Please list your current school and any schools you have attended in the last 3 years.

School Name

Head of School/Principal

Current Teacher Name

Current Teacher Contact Information

City

State

Country

Last Year Attended

From Date

To Date

Last Grade Attended

Has the student ever skipped a grade?

Has the student ever withdrawn or been dismissed from an academic institution or program?

Are there any special concerns?

Current educational support received

Is the student receiving any educational support?

Does the candidate have an IEP?

Add More

Other schools the student is applying to

School Name

City

State

Country

Add More

Please read before submitting your application.
Now that you have reached the final step, you may want to take one last opportunity to review your information prior to submission.
I verify that all the information provided is true and correct to the best of my knowledge

Signature

Date

Applicant

Family

Father

Mother

Mother's Information

Business Address

Father's Information

Business Address

Siblings

Relatives

Grandparents

Medical Information

Current School