Application for Admission

General Information

Student Sex *

Parent Information

Father's Prefix *
Mother's Prefix *
Marital Status of Parents *
Child Lives With *
Are both parents biological parents? *
Are both parents Jewish by birth? *

Sibling Information

How many siblings does the applicant have? *

Applicant Information

Is the applicant currently in the grade appropriate for his/her age? *
Has the applicant undergone any visual, speech, IQ, learning or behavior assessment? *

Has the applicant ever been subject to major discipline problems at any school? *
Has the applicant been under continuing care for any physical, emotional or learning difficulty? *
I/We are prepared to get academic and non-academic assistance as needed if recommended by the school. *

Conclusion and Signature

How did you find out about Epstein Hebrew Academy? Please check all that apply. *
Will you be applying for financial aid? *
By signing this application, you certify that the information provided above is complete and accurate to the full extent of your knowledge. 
Parent/Guardian Signature *
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