Father

Legal Name
Full Hebrew Name
Address
City
State
Zip
Home
Cell
Occupation
Business name
Work Address
City
State
Zip
Work Phone
Fax
E-mail

Mother

Legal Name
Full Hebrew Name
Address
City
State
Zip
Home
Cell
Occupation
Business name
Work Address
City
State
Zip
Work Phone
Fax
E-mail

Legal Name
Date of Birth
Cell Number
Place of Birth

Full Hebrew Name
Date of Birth (Hebrew)
Email
Social Security Number

Student Resides With Both ParentsMotherFatherGuardian (Send Info)

Current/Most Recent School Attended

Phone

Maggid Shiur

Mashpia

Grade level

Was this a good school for applicant(Why/why not? Please explain below)

Last Grade Level of Secular Studies Completed

Name of school

Student Has High School DiplomaGEDSome CollegeNone

Does Student Have a Mashpia/Rabbi/Bochur Who He Is Close With?

Name

Additional Reference

Phone

Phone
Name
E-mail

Email
Relationship

If Time Elapsed Since Student Last Attended School, How Was It Spent?

How Has Student Spent The Past Two Summers?

Does Student Have Any Special Learning Needs?

Does Student Have Any Special Physical or Emotional Needs?

Please Describe Any Special Talents/Skills Student Has (E.g., musical, construction, leining, lifeguarding, etc.)

Please List Student's Extracurricular Interests

In a Few Sentences, Please Describe Students Goals Both Religiously and Academically

Please describe your son’s attitude in the following areas: Scale 1 through 5; 1 being the lowest and 5 being the highest

Please Describe Why Student Is Interested In Joining BTM? Why Would BTM Be A Good Fit For Student? Feel Free To Include Some Of Student’s Accomplishments.

Is There Any Other Factors That You Would Like Us To Consider In Evaluating You Application?

I will pay the $75 fee CheckPayPal/Card

Please note that you must tick the following boxes in order to submit your application

Student: [acceptance] I have completed the above application to the best of my knowledge

Parent: [acceptance] I have completed the above application to the best of my knowledge