Pre-Application Form – Parents

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

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)
City*
State:*
Hebrew Birthday*
Civil Birthdate:*
Current school:*
Father's full name:*
Father's email: *
Father's cell number:*
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Father's profession AND place of work:*
Mother's full name:*
Mother's email:*
Mother's cell number:*
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Mother's profession AND place of work:*
Home phone number:*
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Who referred you to Lev Tmimim?*
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: