| Workflow Admin | |||||||||||||||
| Username | dovihirsch | ||||||||||||||
| CRM EID | 15398 | ||||||||||||||
| Needs Farher | No | ||||||||||||||
| Acceptance Status | Accepted | ||||||||||||||
| Student Information | |||||||||||||||
| Please Upload a Picture of the Student | ![]() | ||||||||||||||
| Student's Name | Dov Ber Hirsch | ||||||||||||||
| Student's Date of Birth | 12/05/2006 | ||||||||||||||
| Student's Regular Cell Phone Number | +17739833834 | ||||||||||||||
| Student's Current Email Address | Email hidden; Javascript is required. | ||||||||||||||
| Student's Current Home Address | One ambassador CT Jackson, New Jersey 08527 United States Map It | ||||||||||||||
| Father's Information | |||||||||||||||
| Father's Full Name | Chana Hirsch | ||||||||||||||
| Cell Phone Number | +18483260187 | ||||||||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||||||||
| Occupation | House wife | ||||||||||||||
| Mother's Full Name | Shlomo Hirsch | ||||||||||||||
| Cell Phone Number | +18483290991 | ||||||||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||||||||
| Occupation | Rabbi | ||||||||||||||
| Parents' Status | Married | ||||||||||||||
| Tuition Payer's Name | Shlomo Hirsch | ||||||||||||||
| Phone Number | +18483290991 | ||||||||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||||||||
| Past Education | |||||||||||||||
| Current Yeshiva | Portnoys | ||||||||||||||
| Past Yeshivas |
| ||||||||||||||
| Elementary School | Yesodei | ||||||||||||||
| Current Rosh Yeshiva Name | Reb shaya Pornoy | ||||||||||||||
| Current Rosh Yeshiva Phone Number | +972548467375 | ||||||||||||||
| Current Rabbi Name | Rabbi avrom Friedman | ||||||||||||||
| Phone Number of Current Rabbi | +17735126220 | ||||||||||||||
| Financial Arrangements | Who will be making financial arrangements for the student's tuition? | ||||||||||||||
| Siblings |
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| Special Circumstances | No | ||||||||||||||
| Please describe the student's special circumstances. | |||||||||||||||
| Student Rules | |||||||||||||||
| Smartphone Policy | I have read and accept the smartphone policy. | ||||||||||||||
| Bochur Signature | |||||||||||||||
| Personal Items | I have read and acknowledge confirmation of the personal items policy. | ||||||||||||||
| Shabbosim and Trips | I have read and acknowledge confirmation of the Shabbosim and trips policy. | ||||||||||||||
| Failure to Follow Rules | I have read and acknowledge confirmation of the policy regarding failure to follow the rules. | ||||||||||||||
| Application Fee | |||||||||||||||
| Billing Address | One ambassador CT Jackson, New Jersey 08527 United States Map It | ||||||||||||||
| Credit Card | Visa XXXXXXXXXXXX0863 | ||||||||||||||
| Application Fee | Application Fee, Qty: 1, Price: $150.00 | ||||||||||||||
| Entry Notes | |||||||||||||||
| Source URL | https://mishkanshmuel.com/application/ | ||||||||||||||
| Source ID | 14 | ||||||||||||||
| Created By (User) | Dov Hirsch |
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I have read and accept the smartphone policy.