Application for Levi Yitzchok Senior Academy

Full Name*

First NameLast Name

Hebrew Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail

Phone Number*

Area CodePhone Number

Please list two references:

1. Name*

Explain how he/she knows you*

Phone*

E-mail

2. Name*

Explain how he/she knows you*

Phone*

E-mail

What is your highest level of education?*

What was your occupation/s?*

Which of the following do you own? (check all that apply)*

I can (check all that apply)*

Read Hebrew and translateRead Hebrew but can't translateNot read HebrewSpeak Yiddish

Please choose which track you are interested in:*

Track 1 (10 AM – 11 AM) Talmudic Study and Jewish MysticismTrack 2 (3 PM – 4 PM) Variety of Judaic Studies (Chassidic Stories, Jewish History, Philosophy, Modern Commentators, Jewish Law)Track 1 & 2 (10 AM -11 AM and 3 PM - 4PM)

What would you like to gain from this program? (Include any specific topics of interest)*

Please tell us a little about yourself? (Include hobbies, volunteering, affiliations, etc)*

I would like to participate periodically.I would like to participate daily.I would like to participate daily and receive an extra bonus for writing the weekly essays.

Thank you for applying to the Levi Yitzchok Senior Academy. Please allow up to two weeks for a response.