Thank you for your interest in Ahavas Chaim.
Please take a few moments to fill out this online form.
All questions on this form must be answered to be considered for acceptance.
All personal information will be held in strictest confidence.

Full English Name *

Hi {{answer_8726592}}, nice to meet you.

Where do you live? *

Can I get your HOME phone number *

Can I get your CELL phone number *

Date of Birth *

Place of Birth *

Are you Israeli or have Israeli ID? *

Have you ever been to Israel before?

Current Address *

Are you a:

What's your Hebrew name?

What's your father's full name *

What's your father's cell number *

Father's occupation *

Is your father an Israeli citizen? *

What's your mother's full name *

Is your mother an Israeli citizen? *

What's your mother's cell number *

Mother's occupation *

How many siblings do you have? 
Can you list their ages for us

Name & contact info of step-parents (if any) *

Family Congregation & Name of Rabbi *

How did you hear of Ahavas Chaim?

Please list name(s) of High School you attended *

Did you graduate High School?

Can you list a reference for us? (name, number, & relationship) *

Can you list another reference for us? (name, number, & relationship) *

Indicate any special characteristics of your physical health, any allergies: *

Have you ever been treated for any emotional disorders? Please specify (all information will be held in strictest confidence) *

If you are taking, or took in the past (on a protracted basis) any medication, for any aspect of your health, please indicate: *

Do you have a relative living in Israel? 
If yes, please state their name & contact info. *

Can you give us an emergency contact, other than a parent (name & contact info) *

Please add anything you feel is important for us to know about you:

Waiver Agreement:
The privilege of studying at Ahavas Chaim is conditional on satisfactory work and adherence to the rules and regulations of the Yeshiva. Ahavas Chaim reserves the right to require the withdrawal of any student for any reason it deems sufficient. Should the student's behavior require suspension, the Yeshiva retains the right to do so. Every student is required to provide a contact in Israel responsible for him during the suspension. Although we do our best to make sure everyone is in a safe place, the Yeshiva is not responsible for a student who has been suspended. Any student who leaves or is asked to leave Ahavas Chaim early, is responsible for a further two months tuition.
Ahavas Chaim is exonerated for any loss by theft or otherwise of any personal belongings, for any personal injury incurred within the premises of Ahavas Chaim, off premises, or on any organized trip. 
By clicking the YES button below you are stating that you have absolutely no claims against Ahavas Chaim for any of the above.
By clicking the YES button, you are certifying that all the information included in this form is true, accurate, and complete to the best of your knowledge; and that you understand that these conditions are to take effect immediately upon your acceptance into Ahavas Chaim. *

The annual tuition for the upcoming year (2015-16) is $21,000. This includes all costs except for flight travel, phone, and medical insurance. To find out about financial aid please be in touch with the office. 
(We would like to reiterate that any student who leaves or is asked to leave Ahavas Chaim early, is responsible for a further two months tuition.)
By clicking the YES button below you are certifying that you agree to pay the tuition amount above, unless a different agreement with the administrator is agreed upon. 


Aren't you thrilled this application process is over?
(WARNING: If you click NO, you may need to start the form again) *

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