| Workflow Admin | |||||||||
| Username | stu90009 | ||||||||
| CRM EID | 16600 | ||||||||
| Needs Farher | No | ||||||||
| Acceptance Status | Pending Acceptance | ||||||||
| Student Information | |||||||||
| Please Upload a Picture of the Student | |||||||||
| Student's Name | Eitan Elin | ||||||||
| Student's Date of Birth | 12/01/2007 | ||||||||
| Student's Regular Cell Phone Number | +12039109268 | ||||||||
| Student's Current Email Address | Email hidden; Javascript is required. | ||||||||
| Student's Current Home Address | 104 Randolph Avenue Waterbury, CT 06710 United States Map It | ||||||||
| Father's Information | |||||||||
| Father's Full Name | Mendy Elin | ||||||||
| Cell Phone Number | +12037472004 | ||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||
| Occupation | Ticket Broker | ||||||||
| Mother's Full Name | Rivka Elin | ||||||||
| Cell Phone Number | +12037685090 | ||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||
| Occupation | Directo of Daycare at Yeshiva Ktana of Waterbury | ||||||||
| Parents' Status | Married | ||||||||
| Tuition Payer's Name | Mendy Elin | ||||||||
| Phone Number | +12037472004 | ||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||
| Past Education | |||||||||
| Current Yeshiva | Yeshiva Yesodai Hatorah | ||||||||
| Past Yeshivas |
| ||||||||
| Elementary School | Yeshiva Ktana Of Waterbury | ||||||||
| Current Rosh Yeshiva Name | Ari Reiss | ||||||||
| Current Rosh Yeshiva Phone Number | +13232403798 | ||||||||
| Current Rabbi Name | Ahron Lander | ||||||||
| Phone Number of Current Rabbi | +12034646705 | ||||||||
| Financial Arrangements | Who will be making financial arrangements for the student's tuition? | ||||||||
| Siblings |
| ||||||||
| 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 | 104 Randolph Avenue Waterbury, CT 06710 United States Map It | ||||||||
| Credit Card | Visa XXXXXXXXXXXX9933 | ||||||||
| Application Fee | Application Fee, Qty: 1, Price: $150.00 | ||||||||
| Entry Notes | |||||||||
| Source URL | https://mishkanshmuel.com/application/ | ||||||||
| Source ID | 14 | ||||||||
| Created By (User) | Mendy Elin |
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I have read and accept the smartphone policy.