Application "*" indicates required fields Step 1 of 7 14% Thank you for your interest in applying toYeshivas Mishkan Shmuel Please follow these instructions when filling out the application: Please provide all requested information in order to prevent delays in your application process. After submitting your application please allow us some time to review. You will be notified via email with our final decision and the “next steps” to take for the acceptance process. IF ANY IMPORTANT INFORMATION HAS BEEN INTENTIONALLY LEFT OUT OR CHANGED (IE: THE REQUESTED CONTACT INFORMATION OR PICTURES) THE RESPONSE WILL BE DISREGARDED For any questions please feel free to contact us at: Office@MishkanShmuel.com Israel- (053) 712-6278 | USA- (347) 761-3817 Whatsapp number: (347) 761-3817 Bochur InformationPlease Upload a Picture of Yourself*(ie the bochur) This should be a passport-style picture from the shoulders up on a plain background. Must be in png or jpg format.Bochur's Name* (Hebrew Name) Last Bochur's Date of Birth* MM slash DD slash YYYY Bochur's Current Cell Phone Number*Bochur's Current Email Address* Bochur's Current Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parents' InformationFather's Full Name* First Last Father's Cell Phone Number*Father's Email Address* Father's Occupation* Mother's Full Name* First Last Mother's Cell Phone Number*Mother's Email Address* Mother's Occupation* Parents' Status* Married Divorced Other Who will be Making Financial Arrangements for Your Tuition?* First Last Best Phone Number to Reach Them*Best Email Address to Reach Them* Copy from father Copy father’s information Copy from mother Copy mother’s information Past EducationCurrent Yeshiva* Past Yeshivas* Add RemovePress the + to add a new YeshivaElementary School*Name of Current Rosh Yeshiva* First Last Phone Number of Current Rosh Yeshiva*Must be filled out in the following format 000 (000) 000-0000 First 3 digits IE: Country code are optional.Name of Current Rabbi* First Last Phone Number of Current Rabbi*Must be filled out in the following format 000 (000) 000-0000 First 3 digits IE: Country code are optional. Family InformationNames and Ages of Siblings*NameAge Add RemovePress the + to add a new sibling Please include step-siblingsAre There Any Special Circumstances We Should Know About?*Please include medical history, family life, and emotional development, if applicable. Talmid RulesSmartphone Policy* I have read accept the smartphone policy.No smartphones or any devices that have internet capabilities are allowed on yeshiva premises. If a Bochur has an Internet capable device he must turn it into the Rosh Hayeshiva upon arrival. Internet devices that are handed in will not be returned on off Shabbosim during Zman.Bochur Signature*Please sign here to confirm that you accept the yeshiva’s smartphone policy.Personal Items* I have read and acknowledge confirmation of the following policy:I grant Yeshivas Mishkan Shmuel permission to disperse or dispose of any personal items, including those with my name on them, which are left by me a week after departure from the Yeshiva, for they will be considered Hefker.Shabbosim and Trips* I have read and acknowledge confirmation of the following policy:I understand that the Yeshiva expects all bochurim to attend all yeshiva in shabbosim and trips. Unless you receive explicit permission from the Rosh Hayeshiva.Leaving the Yeshiva* I have read and acknowledge confirmation of the following policy:If for any reason a Talmid needs to leave the Yeshiva including family simchos, it must be discussed with the Hanhalla before making any arrangements.Failure to Follow Rules* I have read and acknowledge confirmation of the following policy:I have read the above rules and expectations of the Yeshiva from me and hereby accept fully the responsibility to keep them. I understand that if I fail to do so, the decision of my remaining in the Yeshiva or the dormitory will be left up to the discretion of the Hanhalah as they see fit. Application FeeBilling Address* Same as Bochur's current home address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Application Fee Price: CommentsThis field is for validation purposes and should be left unchanged.
