FULL/PART TIME

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FULL-TIME
APPLICATION

STEP 1	Fill out the online application
STEP 2	Email your recent photo to [email protected]
STEP 3	Pay the registration fee ($100) via PayPal or credit card
STEP 4	Interview with Mrs. Holzman in NY, in person or WhatsApp [email protected] \| 917-763-6484
STEP 5	Receive an acceptance letter (up to 3 weeks after applying)
STEP 6	Make tuition arrangements with the office (limited scholarships available)

Personal information

* Indicates required field

Name *

First

Last

First & Last name

Hebrew Names *

First

Last

Hebrew name & Mother's Hebrew name

Date of birth (mm/dd/yyyy) *

Age *

Country of birth *

City of birth *

Home Address (Street Address, City, State, ZIP Code & Country *

Line 1

Line 2

City

State

Zip Code

Country

Student Phone Number *

Place of birth (Country & city) *

Student's email *

Country of citizenship *

Passport Number *

Passport expiration date (mm/dd/yyyy) *

Parents Information

Father's First & Last Name *

Father's occupation (work & Place) *

Father's Cell *

Father's Email *

Mother's First & Last Name *

Mother's occupation (work & Place) *

Mother's Cell *

Mother's Email *

Family Status *

Married Divorced widow

Education

Elementary School (Name & Location) *

Middle School (Name & Location) *

High School (Name & Location) *

Seminary (Name & Location) *

How many years of Seminary *

Principal's Name (First & Last) *

First

Last

Principal's Phone Number *

Or School Number

Languages

English *

Reading comprehension Understands a conversation Speaks None of the above

Hebrew *

Reading comprehension Understands a conversation Speaks None of the above

Yiddish *

Reading comprehension (Sicha...) Speaks Understands a conversation None of the above

Other language *

Choose Any *

Reading comprehension Understands a conversation Speaks

Course of Study

Michlelet Chana offers Kodesh Studies paired with your choice of 2 tracks:
-full time
-part time
Full time:
There is a minimum of 12 Kodesh courses/week to take to be able to attend the program & get a student visa I-20
Part time:
There is a minimum of 4 Kodesh courses/ week to take to be able to learn and live on campus

Choose the track that you would be interested in *

Full time Part time

Will you need accommodations while studying at Michlelet Chana? *

Yes No

References.

Reference name #1 *

First

Last

Relationship to you *

Phone Number *

Reference name #2 *

First

Last

Relationship to you *

Phone Number *

In case of emergency contact

Name *

Relation to you *

Phone number *

Personal Questions

1. How did you hear about Michlelet Chana? *

2. Describe your learning level *

Advanced Intermediate Beginner

3. Describe your personal interests and hobbies *

4. Punctuality in class: How often do you miss classes? Select the option that fits you best *

Always Almost all the times Sometimes Almost never Never

5. Sociability: Select the option that fits you best *

very much gregarious moderately gregarious unsociable

6. Why do you want to study in our school? *

7. What academic skills are you hoping to acquire ? *

8. Did you have any hospitalizations and surgeries in the past? *

Yes No

If yes please list

8. How do you define a Chassidishe home? *

Month/year *

9. Do you have any physical limitations? *

Yes No

Length of hospitalization *

Diagnosis *

Medical Form

1. Do you have any special dietary requirements? *

Yes No

if yes, Please describe *

2. Do you now or have you ever suffered from an eating disorder? *

Yes No

PUT v *

I have read the above and affirm that all information contained in this application is true and accurate to the best of my knowledge.

3. Have you ever received psychological counseling? *

Yes No

if yes, Please provide details *

Month *

4. Do you suffer from any mental or emotional illnesses? *

Yes No

if yes, Please provide details *

Applicant's signature *

Please re-enter your full name

5. Do you suffer from any allergies? *

Yes No

if yes, Allergies details *

6. Do you suffer from asthma, eczema or hives? *

Yes No

7. Do you suffer from any of the following? *

Notes *

if yes, Please Provide details *

10. Do you take any medications *

Yes No

if yes, Please provide details *

Year *

Fees

Registration fee: $100 *

Please choose the method of payment. Go back and make sure all fields marks with red star are filled and then submit the application.

please fill in the following information:

Credit card Number *

Name on Card *

Expiration Date *

CVV *

Zip code *

*Please email a recent picture of yourself and a picture of your passport indicating your name on the email subject,
to
[email protected]

Submit

Contact Us

718.735.4044
[email protected]
556 Crown St, Brooklyn NY 11213

FULL-TIME​APPLICATION

Personal information

Parents Information

Education

Languages

Course of Study

References.

In case of emergency contact

Personal Questions

If yes please list

Medical Form

Fees

Contact Us

FULL-TIME
APPLICATION