AZ Mesivta Student Pre-Application 5783-84

Mesivta Arizona was established to provide the growing need for a complete Mesivta experience of the highest standards.

Our program will provide a warm chassidisher environment where a tomim can grow in nigleh, chassidus, develop self-confidence and maximize their potential.

The learning program is enhanced by Friday afternoon Mivtzoyim, regularly scheduled farbrengens, and guest lecturers.

It is a great program with wonderful potential. It is modelled on the Mesivta in Chicago with an Arizona flavor.

We ask that prior to filling out the application form to please take a moment to consider whether this program is really suitable for your son.

Ultimately, all of us want what is best for our Children. To place a Bochur in a program which he is not yet ready for, or unsuitable for him, will not help him grow or the Mesivta.

Application Details:

1. Decisions for acceptance into the Mesivta of Scottsdale are not made on a "first come first serve" basis, however, the application and report cards should be returned ASAP.

There will be an online form for your sons teacher and principal to fill out. The link for the form will be sent directly the teacher/principal.

2. Only a portion of the applicants will be accepted. Please do not tell your son that he is "going to Arizona next year" so he won’t feel "rejected" if he won’t be accepted, many good Talmidim will end up not getting accepted.

3. There are two stages to apply to the Mesivta, a Pre-application and a Full application.

4. We ONLY interview, Farher, or meet with applicants/Talmidim whose pre-applications have been accepted.

5. The pre-application fee is $150. It is non refundable.

If the application moves forward to a full application, you will have a more detailed form to fill out, and perhaps a Farher and Interview will be set up for your son.

The full application fee is an additional $150. If in the end the applicant is not accepted the $150 will be fully refunded. If the applicant backs out during that stage the $150 will not be refunded.

6. Iy"H and bli neder you will have a response to your pre-application within 4-8 weeks from when we receive it.

Student First and Middle Name*

First Name Middle Name

Student Last Name*

Student English Birth Date*

Month Day Year

Hebrew Birth Day*

Hebrew Birth Month*

Hebrew Birth Year*

Current Age*

Please confirm that you are applying for Shiur Alef/9th Grade*

YesNo

Have you had a son at Mesivta previously?*

YesNo

Father's Title*

Father's Name*

Mother's Title*

Mother's Name*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Email Address*

Mother's Email Address*

Father's Cell Phone Number*

Area Code Phone Number

Mother's Phone Number*

Area Code Phone Number

Please describe any ongoing Medical (severe allergies), social, emotional (anxiety, depression, etc.), scholastic (executive function, ADD/ADHD)*

Please confirm:*

I have listed any medical issues in detail aboveMy son has no known medical, emotional, social or scholastic difficulties.

Please Note: It is in the student’s best interest that there is full disclosure regarding any issues pertaining to the student’s well being. The Mesivta cannot be held responsible for any problems that occur due to information that was withheld. Clear communication is vital to a student’s success in the Mesivta.

In order to process this application, you must have another Mesivta option for your son. Please indicate to which other Mesivta you have applied.*

Please describe your family’s technology, phone and electronic philosophy:*

Do you have a smart phone? *

YesNo

Do you allow your children to have smart phones? *

YesNo

If yes what age do they receive a smart phone? *

What other does technology and or electronics do you have in your home? *

Please list everything applicable

What technology and electronic gadgets does the applicant have access to or own?*

Please list everything applicable

I understand that the Yeshiva’s policy requires kosher phone certification and acceptance into the Mesivta is contingent on compliance with our phone and technology policies Please sign below:*

Enter your name as a signature

*

I confirm that everything written on this form is accurate and true.

Name of School*

Name of Hebrew Principal*

Principal's Phone Number (Cell Phone Preferred)*

Area Code Phone Number

Principal's Email Address*

Primary Teacher's Name*

Teacher's Phone Number (Cell Phone Preferred)*

Area Code Phone Number

Teacher's Email Address*

Name of School*

Name of Hebrew Principal*

Principal's Phone Number (Cell Phone Preferred)*

Area Code Phone Number

Principal's Email Address*

Primary Teacher's Name*

Teacher's Phone Number (Cell Phone Preferred)*

Area Code Phone Number

Teacher's Email Address*

What camp will your son iyH be attending this summer. Please list all camp names if there are multiple options.

Camp Name*

Counselor's Name*

Counselor's Phone Number *

Counselor's Email Address*

Learning Teacher's Name*

Camp Name*

Counselor's Name*

Counselor's Phone Number*

Counselor's Email Address*

Learning Teacher's Name*

Please notify your son's principal and teacher that they will be receiving an online form about your son and it must be completed within ten days. No exceptions.

To complete this part of the process, please send your son's report card from 7th grade and his current 8th grade report card.

Please email report cards to: [email protected].
Your application is not complete until the above is received.

*

I understand that this is a non-refundable registration fee.

*

$300

I understand that:*

the credit card provided shall be stored on-file, and given authorization to be charged should payment-in-full for the agreed upon tuition not be received by the scheduled date.

Payment*

Credit Card

We accept Visa, MasterCard, American Express
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

AZ Mesivta Student Pre-Application 5783-84

AZ Mesivta Pre-Application

Section 1: Student & Parent Information

Section 2: Technology Philosophy

Section 3: Student School Information

8th Grade Information - Current School Year Information - 2022-23

7th Grade Information - Last School Year Information - 2021-22

Summer Information - 2023 (This Summer)

Summer Information - 2022 (This Past Summer)

Summer Information - 2021 (Two Summers Ago)

Section 4: Payment Information

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