Grade 9 Application Form - Tiferes Bais Yaakov

APPLICATION FOR ADMISSION 2023-2024 I 5784

Please carefully complete the entire application.
I wish to be admitted to Grade
month of enrollment
year of enrollment
Prospective Student Information
LAST NAME / ENGLISH
LAST NAME / HEBREW
FIRST NAME/ENGLISH
M.I.
FIRST NAME/HEBREW
NAME AS APPEARS ON BIRTH CERTIFICATE
SOCIAL INSURANCE NUMBER
Address
Street Address City Province Postal Code
HOME PHONE
HOME EMAIL ADDRESS
STUDENT’S CELL PHONE
STUDENT’S EMAIL ADDRESS
DATE OF BIRTH
PLACE OF BIRTH (if foreign, please indicate date of entry)
STATUS IN CANADA (Citizen, Landed Immigrant, Permanent Resident, etc.)
DATE OF ARRIVAL IN CANADA
IF YOU ARE A NATURALIZED CITIZEN PLEASE PROVIDE US WITH A COPY OF YOUR CITIZENSHIP CARD/PERMANENT RESIDENT CARD.
PRESENT SCHOOL
PRESENT GRADE
Parent Information
MARITAL STATUS
- Married
- Divorced
- Separated
- Widowed
- Remarried
FATHER OR GUARDIAN’S NAME (LAST)
TITLE
FIRST NAME
FIRST NAME/HEBREW
FATHER’S ADDRESS (IF DIFFERENT FROM ABOVE)
Street Address City Province Postal Code
FATHER’S EMPLOYER
OCCUPATION
BUSINESS PHONE
HOME PHONE
CELL PHONE
EMAIL
MOTHER’S NAME (LAST)
TITLE
FIRST NAME
FIRST NAME/HEBREW
MOTHER’S ADDRESS (IF DIFFERENT FROM ABOVE)
Street Address City Province Postal Code
MOTHER’S EMPLOYER
OCCUPATION
BUSINESS PHONE
HOME PHONE
CELL PHONE
EMAIL
Family Information
PLEASE LIST THE NAMES, AGES, SCHOOLS AND GRADES OF ALL CHILDREN IN THE FAMILY
Family
NAME AGE SCHOOL GRADE
Previous Schools
PLEASE LIST CHRONOLOGICALLY ALL OTHER SCHOOLS THAT APPLICANT HAS ATTENDED
Schools
SCHOOL GRADE AND YEAR ENTERED GRADUATED (Y OR N)
Summer Camps
PLEASE LIST CHRONOLOGICALLY ALL SUMMER CAMPS THAT APPLICANT HAS ATTENDED
Camps
CAMP YEARS ATTENDED POSITION HELD
List any offices student may have held in school or in any organizations:
List any special talents or skills:
List any work experience (i.e. Tutoring, Volunteering, Summer Jobs other than camp, etc.):
What do you think you can contribute to Tiferes Bais Yaakov:
Personal Information
CONFIDENTIAL WHEN COMPLETED AND SIGNED
PLEASE NOTE: In order to provide the most appropriate educational environment for your daughter, it is crucial for the school to have a full picture of your daughter’s educational and medical background. PLEASE INDICATE “NOT APPLICABLE” WHERE NECESSARY
A. MEDICAL HISTORY AND INFORMATION
1. Please list all medications that your child takes on a regular basis, including non-prescription drugs and vitamins.
NAME OF DRUG/VITAMIN – FREQUENCY:
2. Please list all major operations/surgeries relevant to school life and activities.
B. EDUCATIONAL INFORMATION:
Has your daughter ever been assessed educationally or psycho-educationally? (IF YES, PLEASE PROVIDE DETAILS AND REPORTS)
C. Additional Information
Are there any issues or special circumstances that you would like to discuss at the time of the interview?
- Yes
- No
Is your daughter or either parent converted?
- No
- Daughter
- Mother
- Father
Language spoken at home
Synagogue Affiliation
Personal Rav
PARENT / GUARDIAN’S NAME
DATE
Permission
We allow Tiferes Bais Yaakov to contact our daughter’s elementary school for any information they may require.
- We agree
PARENT / GUARDIAN’S NAME
DATE
Confirmation
Torah Chinuch is a partnership between home and school, and it is crucial that we all work together to ensure a pleasant school experience. Therefore, all applicants and their parents are requested to carefully read the Student Handbook so that the expectations of a Tiferes Bais Yaakov student are clearly understood. Additionally, by signing here you certify that all information in this application is true and accurate. Any false or withheld academic information may result in the rescinding of acceptance.
- I agree - Student
- I agree - Mother
- I agree - Father
Untitled
Date
INCOMPLETE OR UNSIGNED APPLICATIONS WILL NOT BE PROCESSED.
THE FOLLOWING MUST BE INCLUDED WITH THIS APPLICATION:
- Application Fee - payable to Tiferes Bais Yaakov - you will be redirected after submission
- 2 Passport or Digital Photos
- Copy of Hebrew and General Studies Report Card from Grade 7 and Midterm Report Card from Grade 8
- Copy of Birth Certificate
The above items and all Reference Forms can be emailed to secretary@tbyhs.org.
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NAME	AGE	SCHOOL	GRADE

SCHOOL	GRADE AND YEAR ENTERED	GRADUATED (Y OR N)

CAMP	YEARS ATTENDED	POSITION HELD

Prospective Student Information

Parent Information

Family Information

Previous Schools

Summer Camps

Personal Information

Permission

Confirmation