THE YESHIVA OF MIAMI KENESSES YISROEL 7055 Bonita Dr Miami Beach, FL 33141 APPLICATION 2015 2016 תשע" ה תשע"ו Page 1 of 13
Congratulations on taking the first step to ensuring your son a high quality Yeshiva education! Yeshiva of Miami takes the utmost pride in the high quality of our Limudi Kodesh and Limudi Chol programs. We provide our talmidim with a warm and caring academic environment that brings out the strengths of each individual and helps them achieve their goals. Our graduates will possess a love of Torah and learning, the academic ability to attend any advanced educational institution and Sterling Middos Tovos. We are glad you have taken this first step in the application process and look forward to be partners in your son s greatness. Page 2 of 13
Application & Transcript request Application for admission to grade Date Student s Name Address Apt. City State Zip Home Phone Birth Date Hebrew English Social Security # Father s Name & Title Home Address Home & Cell Phone Business Address E-Mail Mother s Name & Title Home Address Home & Cell Phone Business Address E-Mail I / we hereby grant permission for the release of all scholastic records, standardized test scores, health records, attendance records and all documents of commendation and discipline records of my child on file to The Yeshiva of Miami. FATHER S SIGNATURE MOTHER S SIGNATURE STUDENT S SIGNATURE Page 3 of 13
Family information Marital Status Married Separated Divorced Other If Divorced or separated please include custody and court paperwork. Please list other children in your family: Name Age School presently attending Please list Congregations and/or Jewish Organizations with which family is affiliated Name Rav or Presiding Officer Contact information Paternal Grandparents name address Phone number Email Maternal Grandparents name address Phone number Email Page 4 of 13
Student Information Please staple a photo, passport size or larger to this application. Please list in chronological order all schools applicant has attended Name Address & phone Dates of Attendance Contact information Has applicant ever been asked to leave a school or not to return for the new school year? If Yes, please explain Has applicant ever consulted a psychologist, psychiatrist, or any mental health professional? If yes, please submit a copy of evaluation contact information and any other pertinent information. Has the applicant consulted any education professional concerning learning disabilities, gifted potential, physical, occupational, or speech therapy? If yes, please submit a copy of evaluation contact information and any other pertinent information. If any information is incomplete, inaccurate or untrue The Yeshiva of Miami Reserves the right to reverse any commitment made on its part with no refund. Page 5 of 13
Student Information (continued) Mesechta Currently Learning List any Scholarships, Prizes, Contests or other awards you have won: What subjects do you like best? What subjects do you find most difficult? What are your ambitions? Page 6 of 13
Religious Studies Menahel s Report on Applicant Student sname Date Kindly answer the questions below and mail this application to us as soon as possible. Describe student s achievements in each of the following. Please answer all questions. Where not applicable, please indicate. חומש עם פרש''י הלכה גמרא )עם פרש''י ותוספות( )מפרשים( In your opinion, taking into account the applicant s total performance at your school, will he be (please check one) a) a below average student b) an average student c) a good student d) a superior student? If your son is entering 9 th 12 th grade, in your opinion, does the applicant have the proper character and maturity to attend a Yeshiva with a dormitory? Please explain: Kindly check each line at the appropriate point on the scale to show the student s rating in each of the following. Use your own student body as a reference group. נ''ך Acceptance of authority Attitude towards studies Conformity to school regulations Determination Level of Achievement Maturity Relationship with faculty Relationship with peers EXCELLENT VERY GOOD GOOD SATISFACTORY POOR Please enclose a transcript of all of the student s grades that are presently available to you including the present year s quarterly marks and any achievement or other standardized scores that are recorded. Menahel s Name Menahel s Signature Name of Yeshiva Address School Phone Cell Phone Page 7 of 13
Secular Studies Principal s Report on Applicant Student sname Date Kindly answer the questions below and mail this application to us as soon as possible. Describe student s achievements in each of the following. Please answer all questions. Where not applicable, please indicate. 1. Grades Completed (Please encircle): 6 7 8 9 10 11 12 2. Last Year s Final Marks: English Social Studies Math Science Language(.) In your opinion, taking into account the applicant s total performance at your school, will he be (please check one) a) a below average student b) an average student c) a good student d) a superior student? Please explain: Kindly check each line at the appropriate point on the scale to show the student s rating in each of the following. Use your own student body as a reference group. Acceptance of authority Attitude towards studies Conformity to school regulations Determination Reading comprehension Level of Achievement Maturity Relationship with faculty Relationship with peers Excellent Very Good Good Satisfactory Poor Please enclose a transcript of all of the student s grades that are presently available to you including the present year s quarterly marks and any achievement or standardized scores that are recorded. Principal s Name Principal s Signature Cell Phone Name of School School Address School Phone Do not write below this line For office use Entrance Examination Interviewed by: Date Evaluation Page 8 of 13
Yeshiva of Miami - Kenesses Yisroel Tuition contract 2015-2016 5775-5776 6 th - 12 th Grade Tuition Registration $500.00 ($600.00 after May 1st) (multiple children discount available). Tuition: $15,000.00 Subtotal $15,000.00 Give/Get* $1,000.00 (per family) Total $16,500.00 Please note there are no scholarships to Yeshiva of Miami, everyone pays full tuition, there is a tuition deferment plan that allows for more time to pay the full tuition. See the next page for a payment plan. I would like to apply for tuition deferment. Attached is my proposed payment plan. I hereby agree to pay the terms of this contract by June 2016. Parent or guardian responsible for tuition s signature Print Name Date All students must abide by The Yeshiva of Miami - Kenesses Yisroel Handbook and all rules and regulations of the School. The Yeshiva of Miami - Kenesses Yisroel admissions are not finalized until a signed tuition contract and post dated checks or a credit card are on file. Page 9 of 13
Tuition Payment schedule My payments of after all government scholarship programs will be made with (check one) Head checks Credit card My payments will be made on the following schedule $ Now $ In July 2015 $ In August 2015 $ In September 2015 $ In October 2015 $ In November 2015 $ In December 2015 $ In January 2016 $ In February 2016 $ In March 2016 $ In April 2016 $ In May 2016 $ In June 2016 The remainder of Will be paid at a rate of $ per month until 20 There will be no refunds given if the student is removed from school by the parents. Tuition is earned on a quarterly basis. Parent must inform the school within 15 calendar days of the beginning of the academic quarter to receive a weekly prorated.tuition. Waivers will be granted at the discretion of the Yeshiva on a case by case basis. Third party scholarships will not be refunded (Florida Pride, CAJE, and give or get ect.) I pledge to pay the full tuition as per the above agreement, I pledge to make payments every month and keep making payments until the full tuition is paid. Page 10 of 13
The Yeshiva of Miami Kenesses Yisroel Registration Emergency Contact Information and Medical Authorization 2015-2016 PLEASE PRINT CLEARLY. Child s Name Date of Birth Grade Allergies Medications Father s Name Address Home Phone Cell Work E-Mail Mother s Name Address Home Phone Cell Work E-Mail Emergency Contact Home Phone Cell Work Insurance Carrier/Number Insurance Card on File? Authorization needed for treatment? Yes / No Primary Physician Address Phone Dentist Address Phone Other Doctors Permission to Administer Tylenol/Advil? Yes / No (circle one) Notes/Comments Parental Permit I hereby give permission for legal, diagnostic, therapeutic and operative procedures as may be deemed urgent and necessary by a school administrator, physician or other health-care professional for my child. Name Signed Relationship Date Page 11 of 13
Release Form PLEASE PRINT Registration Date Grade Entering Student s Name Address Apt # City State Zip Home Phone Cell I/We understand that the The Yeshiva of Miami Kenesses Yisroel may plan various field trips during the course of the year. I/We hereby give permission for my son to participate in these field trips. I/We hereby acknowledge that my son(s) may be photographed or video-recorded and these images may be used by the The Yeshiva of Miami Kenesses Yisroel for promotional purposes on line or otherwise. I, the undersigned, have read and understand all the rules, requirements and ideas put forth in this year s Student-Parent handbook. I will adhere to these rules and contribute to the goals of the school. I understand that my enrollment at the The Yeshiva of Miami Kenesses Yisroel is dependent upon adherence to these rules. I/We commit to abide by all rules and regulations of the Yeshiva. I realize that I must always act and dress appropriately of a yeshiva bochur even outside the The Yeshiva of Miami Kenesses Yisroel and outside The Yeshiva of Miami Kenesses Yisroel school hours. This also includes not walking in the streets in without tzitzis or otherwise inappropriately. This includes the required yarmulke in its proper size with whatever you need to keep in place. I/We hereby acknowledge that enrollment at the The Yeshiva of Miami Kenesses Yisroel is dependent upon the maintenance of regular attendance and maintenance of required academic and behavioral performance. The talmid is required to familiarize himself with and abide by all rules and regulations of the school. I/We understand that not adhering to any of the above is grounds to be expelled from the The Yeshiva of Miami Kenesses Yisroel. FATHER S SIGNATURE Date MOTHER S SIGNATURE Date STUDENT S SIGNATURE Date Page 12 of 13
For your convenience, we have included a description of the process to enroll your son in Yeshiva of Miami and a checklist. 1) Application completed and returned to YoM 2) Interview is scheduled 3) Student and parent interview and Q & A 4) Acceptance letter received 5) Registration 6) Attend first day of Yeshiva Application checklist (Pages 1 7 of this form) [] Records and Principal s report from previous school [] Educational/Psycho-educational testing reports [] Grandparents Contact [] Application fee, $125 Registration checklist (pages 9-11 of this form) [] Signed tuition contract [] Tuition in full, Post-dated checks (Advance payment) or Monthly credit card authorization form & payment schedule [] State of Florida health form [] Immunization Record (If you do not immunize your children you MUST obtain a religious exemption form from the Florida Health Department) [] Copy of Birth Certificate [] Copy of Social Security card [] Copy of Insurance card [] Emergency Contact Form [] Internet Acknowledgement [] Release Form [] Registration fee $600 ($500 before May 1 st ) Please remember that without these forms and supporting documentation, your son(s) will not be enrolled in the The Yeshiva of Miami Kenesses Yisroel. Page 13 of 13