Application for Levi Yitzchok Senior Academy

1. Please choose which track you are interested in:

Track 1A Men's Academy (Sunday thru Friday,10:00 a.m. – 11:00 a.m.) Talmudic Study and Jewish MysticismTrack 1B Women's Academy (Monday thru Thursday, 11:15 a.m. – 12:15 p.m.) Variety of Judaic topics applicable to womenTrack 2 for men & women (Sunday thru Thursday, 3:00 p.m. – 4:00 p.m.) Variety of Judaic Studies (Jewish History, Jewish Law, weekly Torah portion with modern commentaries and guest speakers from around the world)Tracks 1 & 2

2. I can (check all that apply)

Not read HebrewRead Hebrew but can't translateRead Hebrew and translateSpeak Yiddish

3. Please choose one of the following:

I would like to do a trial periodI would like to participate daily.I would like to participate daily and receive a monthly payment.I would like to participate periodically.

4. Full Name

First NameLast Name

5. Hebrew Name

6. Address

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

7. E-mail

8. Phone Number

Area CodePhone Number

Please list two references:

9. Reference 1: Full Name

First NameLast Name

Explain how he/she knows you

Phone Number

Area CodePhone Number

E-mail

10. Reference 2: Full Name

First NameLast Name

Explain how he/she knows you

Phone Number

Area CodePhone Number

E-mail

11. What is your highest level of education?

12. What was your occupation/s?

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

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

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

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

Application for Levi Yitzchok Senior Academy

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