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| Workflow Admin | |||||||||||
| Username | dovidbaruch | ||||||||||
| CRM EID | 17159 | ||||||||||
| Needs Farher | No | ||||||||||
| Acceptance Status | Accepted | ||||||||||
| Student Information | |||||||||||
| Please Upload a Picture of the Student | ![]() | ||||||||||
| Student's Name | Dovid Baruch | ||||||||||
| Student's Date of Birth | 31/10/2004 | ||||||||||
| Student's Regular Cell Phone Number | +14435806084 | ||||||||||
| Student's Current Email Address | Email hidden; Javascript is required. | ||||||||||
| Student's Current Home Address | 6242 Woodcrest Ave Baltimore, Maryland 21209 United States Map It | ||||||||||
| Father's Information | |||||||||||
| Father's Full Name | Sender Baruch | ||||||||||
| Cell Phone Number | +14109497331 | ||||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||||
| Occupation | System's Engineer | ||||||||||
| Mother's Full Name | Tzipporah Baruch | ||||||||||
| Cell Phone Number | +14108123589 | ||||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||||
| Occupation | Playgroup Morah | ||||||||||
| Parents' Status | Married | ||||||||||
| Tuition Payer's Name | Sender Baruch | ||||||||||
| Phone Number | +14109497331 | ||||||||||
| Email Address | Email hidden; Javascript is required. | ||||||||||
| Past Education | |||||||||||
| Current Yeshiva | Ner Yisroel | ||||||||||
| Past Yeshivas |
| ||||||||||
| Elementary School | Torah Institute | ||||||||||
| Current Rosh Yeshiva Name | R' Aharon Feldman | ||||||||||
| Current Rosh Yeshiva Phone Number | +14104847200 | ||||||||||
| Current Rabbi Name | R' Mordechai Shafran | ||||||||||
| Phone Number of Current Rabbi | +14104840387 | ||||||||||
| 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 | 6242 Woodcrest Ave Baltimore, Maryland 21209 United States Map It | ||||||||||
| Credit Card | Visa XXXXXXXXXXXX8997 | ||||||||||
| Application Fee | Application Fee, Qty: 1, Price: $150.00 | ||||||||||
| Entry Notes | |||||||||||
| Source URL | https://mishkanshmuel.com/application/ | ||||||||||
| Source ID | 14 | ||||||||||
| Created By (User) | Dovid Baruch |
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I have read and accept the smartphone policy.