Application for Levi Yitzchok Senior Academy

1. Please choose which track/s you are interested in: (check all that apply)

Track 1 Men's Academy (Sunday thru Friday,10:00 a.m. – 11:00 a.m.) Talmudic Study. This class is FREE. Participants are also eligible to receive a monthly payment as an incentive to join daily and write 1 weekly essayTrack 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) This class is FREE. Participants are eligible to receive a monthly payment as an incentive to join daily and write 1 weekly essayTrack 3 Women's Academy (Wednesdays at 12:30 p.m. -1:15 p.m.) A "Women Only" Torah class. This class is FREETrack 4 special guest speaker program. (every Thursday at 3:00 p.m. we try to have guest speakers share insights and inspiration with us) This class is FREE

2. I can (check all that apply)

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

3. If you are interested in the daily classes (Track 1 or 2) then fill this out. For once-a-week classes (Track 3 or 4), leave this blank and proceed to question 4.

I would like to participate but I do not want to write the 1 weekly essayI would like to participate and write 1 weekly essay but I do not care for the monthly payment incentiveI would like to participate daily and write 1 weekly essay and I would like to receive the monthly payment incentive

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.

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