Nishmat - The Jeanie Schottenstein Center for Advanced Torah Study for Women

Application - Alisa Flatow Overseas Students Summer Program

To apply to the 2010 summer program, fill out the on-line form below or download a printable version.

A non-refundable application fee of $50.00 ($30 for part-time application) is required in order to process your request. You may pay by check (made payable to Nishmat) or with a credit card by downloading our credit card form. Students who finalize payment by May 16, 2010 will not be charged the $50 application fee.

Printed applications and checks should be sent to Nishmat, 26a Berel Locker Street, Pat Neighborhood,Jerusalem 93282 Israel

Printed applications, credit card forms and copies of checks (before sent by mail) should be faxed to Nishmat at +972-2-6404353

Within the application's text boxes below, please type your answers using regular English characters. Do not paste text from Microsoft Word, web pages or any other sources.

1. Summer application for:

Full-Time Part-Time

If part-time, which classes are you applying for?

Course:

2. Period of Study:

July for For exact dates, click here.

*If registering for two weeks, please specify which weeks:

3. Do you want dormitory accommodations? (Available only for full-time students.)

No Yes

If yes, please indicate below the number of years that you have lived away from home:

Summer Camp: College: Abroad: Independently:

4. Name:

First:

Last:

Hebrew:

5. Occupation:

Position:

Employer:

6. Current Residence:

Address:

City/State:

Country/Code:

Phone:

Fax:

Email:

7. Permanent Residence:

Address:

City/State:

Country/Code:

Phone:

Fax:

8. Birth:

Date (DD/MM/YY):

Place:

Father's Name:

9. Citizenship (Please fill out ALL relevant information):

Nationality:

Passport Number:

If Israeli citizen*, Te'udat Zehut number:

*Israeli citizens are eligible for reduced tuition charges.

If US citizen, Social Security Number:

10. Marital Status:

Single Married Divorced Widowed

Husband's Name:

Occupation:

Number of children:

11. Medical Information (Confidential):

Any medical conditions? No Yes
If yes, please specify:

Medications?

Are you under a doctor's care? No Yes
If yes, please specify:

Are you receiving mental health counseling? No Yes
If yes, please specify:

Psychiatric care? No Yes
If yes, please specify:

12. Education:

Secondary School Name:

Address:

Year Graduated:

College Name:

Address:

Year Graduated:

Major:

Other:

Address:

Year Graduated:

Major:

13. Jewish Education, if different from answer 11:

School Name:

Address:

Year Graduated:

School Name:

Address:

Year Graduated:

14. Hebrew Skills:

Excellent, with little use of a dictionary; Good, with dictionary; Fair, with dictionary;
Poor, Could do with difficulty; None Could not do at all.

	Excellent	Good	Fair	Poor	None
Reading:
Writing:
Speaking:

15. Hebrew Comprehension:

Please indicate your skill level in the following:

	Excellent	Good	Fair	Poor	None
Chumash:
Rashi on Chumash:
Ramban on Chumash:
Mishnah Brurah:
Mishnah:
Gemara:

16. How did you first hear about Nishmat?

Brochure
Alumnae
Nishmat Staff
Web Site
Other Please specify:

17. What synagogue or minyan do you attend?

Name of synagogue or minyan:

Rabbi:

Synagogue Address:

Contact: NISHMAT 26a Berel Locker Street, Pat Neighborhood,Jerusalem 93282 ISRAEL
Email: Phone: +972-2-6404333 Fax: +972-2-6404353
Women's Halachic Hotline: +972-2-640-4343 Toll free from the United States and Canada: 1-877-963-8938