Pre-Application Form – Parents

This form is for the parents to complete. Please also have your son submit the Talmid form.

This application is for:*

Last name of Bochur:*

First name of Bochur:*

What Shiur are you applying for? (If you are applying for Shiur ב׳ or ג׳ please first contact the Hanhola)

We are applying for:

City*

State:*

Hebrew Birthday*

Civil Birthdate:*

Current school:*

Father's full name:*

Father's email: *

Father's cell number:*

Area Code

Phone Number

Father's profession:*

Father's place of work (company or organization):*

Mother's full name:*

Mother's email:*

Mother's cell number:*

Area Code

Phone Number

Mother's profession:*

Mother's place of work (company or organization):*

Home phone number:*

Area Code

Phone Number

Who referred you to Lev Tmimim?*

Please share with us your hope for your son at Mesivta Lev Tmimim. In other words, what are the primary goals you are seeking that led to your decision to apply to MLTL as an option for your son's education (select as many as are relevant):*

Higher academic level and focus and learning

Emphasis on Yiras Shomayim

Social development and emotional wellbeing

Nurturing leadership traits and personal growth

My son is struggling academically in his current school and needs more support

My son is struggling emotionally/socially in his current school and needs more support

My son is struggling spiritually/religously in his current school and needs more support

Not sure, someone just recommended MLTL

My son was not accepted anywhere else, so applying anywhere we can

Other (*please explain below)

*Other:

Please BRIEFLY provide any other pertinent information or notes about your son that you'd like to let us know about at this stage. Please note that in step two, the full application form will be emailed to you, with more comprehensive questions about your son's education:*