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Workflow Admin
DEPRECATED Usernameaaron
PARENT CRM EID12881
Account Information
DEPRECATED Bochur's Name
Your Bochur's NameAvi Noam Noam Dembitzer
Bochur is aNew Student
Bochur EID
Your NameShmuli Dembitzer
Phone Number+12032521600
Email AddressEmail hidden; Javascript is required.
Health Insurance

IT IS MANDATORY THAT EVERY TALMID HAS HEALTH INSURANCE WHILE IN YESHIVA.
You will receive an email with more information about obtaining health insurance, upon submitting this form.

Tuition and PaymentsStandard tuition is $2,300.00 per month.
Scholarship RequestI will pay full tuition
Requested Monthly Tuition
Confirmed Monthly Tuition$2,300.00
WARNING - Reduced Tuition
Payment OptionsCredit Card
Name on Account
Account Type
Account Number
Routing Number
Tuition Electronic Debit Consent
Third Party Organization
Other Third Party Organization Name
Tuition Credit Card Consent I have read and confirm understanding of the following:
On the 1st of every English calendar month, Yeshivas Mishkan Shmuel will charge the credit card labeled "Tuition" above for the agreed-upon amount of my son's monthly tuition.
Expenses Credit Card Consent I have read and confirm understanding of the following:
Yeshivas Mishkan Shmuel will charge the credit card labeled "Expenses" above at various times for the amount of $300 each, for the periodic Shabbatons on which the Yeshiva takes all enrolled students. Additionally, in the case that my son arrives to yeshiva without medical insurance, the credit card labeled "Expenses" above will be charged for the cost of obtaining a medical insurance policy for him.
Important Documents
Upload Picture of Bochur's PassportUpload Picture of Bochur's Passport
Upload Picture of Bochur's Birth CertificateUpload Picture of Bochur's Birth Certificate
Bochur's Legal NameAvi Dembitzer
Bochur's Passport NumberA13522585
Bochur's Date of Birth19/11/2006
Bochur's Passport CountryUSA
Bochur's Passport Issued On13/06/2023
Bochur's Passport Expires On12/06/2033
Does the Bochur Need a Visa?No
Upload Picture of Bochur's Valid Visa
Mispar Zehut
Upload Picture of ID with Mispar Zehut
Visa ForMyself
Missing
Visa InformationA Student Visa is typically valid for 2 years. The yeshiva will oversee the Student Visa application process. There is a $200 processing fee.
Father's Name
Father's Date of Birth
Are either of the parents Israeli?
Mother's Name
Mother's Date of Birth
Mother's Maiden Name
Tuition Contract StatusAccepted
Entry Notes
Source URLhttps://mishkanshmuel.com/tuition/?page=gravityflow-inbox&view=entry&id=1&lid=12702&studentname=Dembitzer
Source ID145
Created By (User)