Dashboard - Admin - Pending Tuition Contracts

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	Workflow Admin
DEPRECATED Username	1shuli
PARENT CRM EID	17209
Account Information
DEPRECATED Bochur's Name
Your Bochur's Name	Dovid Baruch
Bochur is a	New Student
Bochur EID	17177
Your Name	Sender Baruch
Phone Number	+14109497331
Email Address	Email 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 Payments	* Tuition is $2,300.00 per month. *
Scholarship Request	I would like to request a reduced tuition
Requested Monthly Tuition	$1,150.00
Confirmed Monthly Tuition	$1,150.00
WARNING - Reduced Tuition	I understand and agree to the below You have indicated that you would like to request a reduced tuition. Please note that all tuition reduction requests will be submitted to the Rosh Yeshiva for review and approval. There is no set timeframe for this process and it may impact your son's ability to enter the zman on time.
Payment Options	Credit 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: Tuition will automatically be charged to the "Tuition" credit card above, on the 1st of every English calendar month, for the agreed-upon amount as per this agreement.
Expenses Credit Card Consent	I have read and confirm understanding of the following: It is required that every parent supply the Yeshiva with an expense credit card. This card will be used for the extra "Achdus Shabbatonim" the yeshiva plans at various times throught the year, in the amount ranging between $300 - $500. This expense card will also be used in the event your son arrives to Yeshiva without the required Health Insurance, Proper kosher phone, and the Student visa application.

Important Documents
Upload Picture of Bochur's Passport
Upload Picture of Bochur's Birth Certificate
Bochur's Legal Name	David Baruch
Bochur's Passport Number	A13256425
Bochur's Date of Birth	31/10/2004
Bochur's Passport Country	USA
Bochur's Passport Issued On	24/03/2023
Bochur's Passport Expires On	23/03/2033
Does the Bochur Need a Visa?	Yes
Upload Picture of Bochur's Valid Visa
Mispar Zehut
Upload Picture of ID with Mispar Zehut
Visa For	Myself
Missing
Visa Information	Bochurim are required to maintain a valid student visa throughout their stay. The yeshiva will oversee the Student Visa application process via our third party processor "Israelexpat.com". The Expense credit card entered above will be used to cover their fee.
Father's Name	Allen Baruch
Father's Date of Birth	17/07/1968
Are either of the parents Israeli?	Neither
Mother's Name	Dina Baruch
Mother's Date of Birth	05/01/1971
Mother's Maiden Name	Hoenlein

Tuition Contract Status	Accepted
Entry Notes
Source URL	https://mishkanshmuel.com/tuition/?payer_first=Sender&payer_last=Baruch&payer_email&parent_id=17177&student_full_name=Dovid+Baruch
Source ID	145
Created By (User)	Sender Baruch