Full Name (First, Middle if you have one, Last)
Gender and Preferred pronoun(s)

Email

Permanent Home Address
Street Address
City, State, Zip and Country

Mailing Address
Street Address
City, State, Zip and Country

Cell Phone Home Phone
Birthdate
CitizenshipUSPermanent Resident USOther
Other Citizenship

List all secondary and high schools attended. Please enter Name of School, Address, Dates Attended and Graduation Year.

List all colleges and universities attended. Please enter Name of School, Address, Dates Attended, Graduation Year and Degree(s) Granted. Please have a transcript sent from each institution as soon as possible.

If you are currently attending school, please describe your extracurricular activities. If you are not currently attending school, please describe your activities since. Please list your principal extracurricular, community, and family activities and hobbies in the order of their interest to you.
Include specific events and/or major accomplishments such as acting roles played, varsity letters earned, etc.

Briefly describe any scholastic distinctions or honors you have won in college:

Jewish Background:
OrthodoxConservadoxConservativeReformReconstructionistKosherOther
Date of Bar/Bat/Bax Mitzvah
Length of time studied Hebrew
Briefly discuss your observance practices related to Jewish rituals, customs, and holidays. Tell us your favorite holiday!

What is your degree of hearing loss?
ProfoundSevereModerateMildNone
Primary method of communication
Sign LanguageSpeechSpeech, and I sign fluently
Foreign Language Proficiency (please list and describe):

Work Experience: Please list any job (including summer employment) you have held during the past three years. List the nature of your work, your employer, dates of employment and average number of hours per week.

In the space provided below, briefly discuss which of these activities (extracurricular and personal activities or work experience) has had the most meaning for you, and why. Tell us something interesting!

Personal Statement: Please discuss why you are interested in studying at the Hebrew Seminary, A Rabbinical School for the Deaf & Hearing. You may use the back of this page and attach extra pages if your essay exceeds the limits of this form.
Be interesting and compelling! Tell us about yourself! We love reading your essays.

What is the numerical value for Chai? (hint: double chai is 36)