Application

Bais Medrash Registration 2022-2023

Welcome to the Heichal HaTorah Bais Medrash! We look forward to having you join us!
Student Information
Student's Name*
First Middle Last Likes to be called
Student's Birth Date*
Date Format: MM slash DD slash YYYY
Student's Email*
Cell Phone*
Parent Information
Home Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Primary Email*
Billing Address (If different from above)
Street Address Address Line 2 City State ZIP Code
Father's Name*
Title First Last
Father's Email*
Father's Cell Phone*
Father's Work Phone
Father's Address (If different from above)
Street Address Address Line 2 City State ZIP Code
Mother's Name*
Title First Last
Mother's Email*
Mother's Cell Phone*
Mother's Work Phone
Mother's Address (If different from above)
Street Address Address Line 2 City State ZIP Code
Name of High School Attended*
Name of Israel Yeshiva Attended*
Reference Name, Phone Number and Relationship to Applicant*
Dorm*
- I will be living in the Heichal HaTorah Bais Medrash dorm.
- I will be living at home
Registration*
- I am registering for 22-23. Registration fee is $1,000.
- I am registering for Post Pesach 2022. Registration fee is $500. Tuition balance of $500 will be due by May 1, 2022.
This fee is for the registration only, and not for the total tuition amount.
Payment Method*
- I will pay the non-refundable registration fee for 22-23 by credit card via Paypal
- I will mail in a non refundable check for the registration fee for 2022-2023 to Heichal HaTorah (70 Sterling Place, Teaneck NJ 07666)
- I will pay the non-refundable registration fee for Post-Pesach 2022 by credit card via PayPal
- I will mail in the non-refundable registration fee for Post-Pesach 2022 to Heichal HaTorah (70 Sterling Place, Teaneck NJ 07666)
If you have any questions regarding payment, please email Mrs. Teri Normand, Executive Director and CFO, at tnormand@heichalhatorah.org
Total
$0.00

Bais Medrash Registration 2022-2023

Student Information

Parent Information