Yeshiva of Spring Valley Application

We are pleased that you are considering Yeshiva of Spring Valley for your child’s chinuch and look forward to learning more about your child and family. To begin the admissions process, please complete the application form below. The form may be submitted only after all required (*) fields are completed.
Kindly note that the application cannot be saved prior to submission, so you will need to have all the necessary documents ready before you begin.
You will need the following items to complete the application:

Proof of Birth

Current Immunization Records

Applicant Picture

Evaluations and IEP (if applicable)

Recent Scholastic Records (required for grades 1-8 only)

If you have any questions regarding the admissions process or require assistance, please contact Mrs. Hennie Thau at [email protected].

Student

Please upload a recent image of the applicant*

Last Name*

First Name*

Legal Name*

Hebrew First Name*

Hebrew Last Name*

Gender*

Select Below*

Applying To Grade*

Date of Birth*

Born Past Shkiah

Natural Child

Adopted Child

Schools / Playgroups

Name of Current School / Playgroup*

Grade*

Address*

Number*

Name of Previous School / Playgroup

Grade

Address

Number

History

List any medical conditions or allergies*

Has your child ever received special educational or psychological services or testing?*

Please list any developmental, behavioral or learning issues your child may have or any other specific information that you feel may be useful in evaluating the needs of your child*

Parent Information

Parents' Marital Status*

Home Phone Number

Address*

Country*

City*

Zip*

Is any language in addition to, or other than, English spoken in the home?*

Is either parent a native speaker of a language other than English? *

Is there any history of "Geirus"?*

Father

Title*

First Name*

Hebrew Full Name*

Cell Number*

Email*

Profession or Business

Profession*

Work #

Business Address*

City*

Zip*

Schooling

Elementary*

High School*

Post High School

Mother

Title*

First Name*

Hebrew Full Name*

Maiden Name*

Cell Number*

Email*

Profession or Business

Profession*

Work #

Business Address*

City*

Zip*

Schooling

Elementary*

High School*

Post High School

Siblings

List All Children (18 Years and Younger)

First Name*

Age*

Current Grade*

School*

Add More

References

Please list references that know you and your family, such as a Rav or YSV Parent

Name*

Telephone*

Relationship*

Name*

Telephone*

Relationship*

Name*

Telephone*

Relationship*

Shul Family Attends on a Regular Basis*

Rav's Name*

Rav's Number*

Grandparents

Please list grandparent info requested below. If inapplicable, please click the 'x' to your right:

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*

Country*

City*

Zip*

Please list grandparent info requested below. If inapplicable, please click the 'x' to your right:

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*

Country*

City*

Zip*

Add More

Forms

Please Upload:

Proof of Birth:*

Choose file

Current Immunization Records:*

Choose file

Additional Immunization Records

Choose file

Agreement

This is an application only. No child shall be deemed as having been accepted for admission to the Yeshiva until having received an acceptance letter and a tuition contract has been executed and approved by an officer of our institution.
Children must be fully immunized in accordance with New York State requirements.
I hereby authorize Yeshiva of Spring Valley to obtain all scholastic and medical records and perform testing and evaluations of my child as deemed necessary.
I hereby authorize my child's school district to share all information regarding my child with Yeshiva of Spring Valley.

The above is understood and the information provided is accurate and complete to the best of my knowledge.

Father's Signature*

Mother's Signature*

Date*