Application Form | Darchei Sholom

Student Application Form

Thank you for applying to ישיבת דרכי שלום.

This form must be completed by the Applicant’s parent or legal guardian on the talmid’s behalf.

Please submit the completed form to, together with a photocopy of Applicant’s birth certificate and a photograph of the applicant.

A photocopy of the applicant last two years school reports are requested, together with the current or most recent EHCP and Annual Review documentation.

First Name

Last Name

Date of Birth

Hebrew Name

Parents Phone Number

Parents Email Address

Address

Does the applicant live at this address permanently:

Yes

Fathers Name

Mothers Name (+ maiden)

Fathers Hebrew Name

Mothers Hebrew Name

Name and contact details for current מנהל

Family קהילה / Shul membership

EHCP & Annual Review documents

Upload File

Upload supported file (Max 15MB)

Name and contact details for current גמרא / Class Rebbe

School Reports

Upload File

Upload supported file (Max 15MB)

Photograph of Talmid

Upload File

Upload supported file (Max 15MB)

PART 2. MEDICAL

Does the Applicant have any medical requirements of which the ישיבה will need to be aware of? If so, please provide brief details below of medical condition and medication.

Condition/Diagnosis - Please Inclide Medication

Physical Disabilities - Please Include Treatment

Has the Applicant received psychological/psychiatric treatment and/or counselling in the past? (Pease Include details and any treatement done)

Does the Applicant have any allergies / intolerances?

PART 3. EDUCATION

Please list details of the Applicant’s Primary and Secondary School education

Name of Primary / Secondary School Name + Dates & SEN Unit

Summer Camps at Secondary School level.

Details of alternative or additional קודש studies

Details of alternative of additional Secular studies

If so, maintained by which Local Education Authority:

I confirm that all the above information is correct and, in accordance with GDPR regulations, will be kept strictly confidential. I also understand that interviews will be held, to ascertain whether our ישיבה is suitable for the applicant.

Fathers Signature

Full Name

Select a date

Mothers Signature

Full Name

Select a date

Thanks for submitting!