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| Workflow Admin | |||||||
| Username | dira24 | ||||||
| CRM EID | 17257 | ||||||
| Needs Farher | No | ||||||
| Acceptance Status | Accepted | ||||||
| Student Information | |||||||
| Please Upload a Picture of the Student | ![]() | ||||||
| Student's Name | ELI BECK | ||||||
| Student's Date of Birth | 15/01/2007 | ||||||
| Student's Regular Cell Phone Number | +17328951402 | ||||||
| Student's Current Email Address | Email hidden; Javascript is required. | ||||||
| Student's Current Home Address | 1835 Regina Court Toms River, NJ 08755 United States Map It | ||||||
| Father's Information | |||||||
| Father's Full Name | Mayer Beck | ||||||
| Cell Phone Number | +17325341050 | ||||||
| Email Address | Email hidden; Javascript is required. | ||||||
| Occupation | Flooring | ||||||
| Mother's Full Name | Naomi Beck | ||||||
| Cell Phone Number | +17325341686 | ||||||
| Email Address | Email hidden; Javascript is required. | ||||||
| Occupation | mother | ||||||
| Parents' Status | Married | ||||||
| Tuition Payer's Name | Mayer Beck | ||||||
| Phone Number | +17325341050 | ||||||
| Email Address | Email hidden; Javascript is required. | ||||||
| Past Education | |||||||
| Current Yeshiva | Yeshiva gedola of Elkins Park | ||||||
| Past Yeshivas |
| ||||||
| Elementary School | Tashbar of Lakewood | ||||||
| Current Rosh Yeshiva Name | R' Heshy Rubanowitz | ||||||
| Current Rosh Yeshiva Phone Number | +19177332756 | ||||||
| Current Rabbi Name | R' Heshy Rubanowitz | ||||||
| Phone Number of Current Rabbi | +19177332756 | ||||||
| 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 | 1835 Regina Court Toms River, NJ 08755 United States Map It | ||||||
| Credit Card | Visa XXXXXXXXXXXX8737 | ||||||
| Application Fee | Application Fee, Qty: 1, Price: $150.00 | ||||||
| Entry Notes | |||||||
| Source URL | https://mishkanshmuel.com/application/ | ||||||
| Source ID | 14 | ||||||
| Created By (User) | ELI BECK |
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I have read and accept the smartphone policy.