Out of town - MONSEY BEIS CHAYA MUSHKA

Student Name
First NameLast Name
Parents please fill this part out
Why are you interested in sending your daughter out-of-town?
Do you feel your daughter is ready for a school experience away from home ? Please explain:
Please provide the names and telephone numbers of two adults whom we may contact for additional reference
Name
Phone
Relation to your daughter
Name
Phone
Relation to your daughter
Please provide the name and telephone numbers of your Rav/Rabbi/Shliach.
Name
Phone
Student Application
To be completed by Applicant
Name you prefer to go by
What books have you most enjoyed reading during the past year and why?
What are some of your favorite things to do when you have free time?
Name three things you believe you are good at doing?
Which summer camps did you attend?
Which summer camp or summer experience had the most positive effect on you and why?
Has anyone (outside your parents) had a positive impact on you? Explain why?
Do you have a Mashpia ? How often are you in contact with her?
Do you say Chitas on a daily basis?
How would you describe your standard of Tznius?
Describe any Mivtzoyim in which you participate now or have participated in the past:
What role does Chassidus play in your life?
Name one of your favorite subjects in school, and Why?
Describe the qualities of your favorite teacher:
What extracurricular activities would you like to participate in while in High School?
Please tell us something that you would like us to know about you that is not included in this application:
Please download the two principal forms and have your current school's office email or fax them TOGETHER WITH 7th and 8th grade report cards.
email: office@monseybcm.com (put student's name in subject line)
fax: 845-634-7422
Kodesh Principal Form
Chol Principal Form
Should be Empty:

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Parents please fill this part out

Student Application