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STEP 1: Registration for New Students
MACHON CHANA Women's Institute
»
Our Programs
»
iLearn
»
Registration
»
STEP 1: Registration for New Students
Registration for New Students
Registering for iLearn involves completing a registration form, emailing us a current photo, and making payment arrangements. Please fill out the form carefully as it enables us to design a program of study tailored to each individual student’s needs and requests. For more information please contact us at ilearn@machonchana.org or call (718) 735-0030 (ext. 106)
How are you going to join the classes?
*
In person
Online
I. Personal Information
Name
*
First
Last
Date of Birth
*
MM
DD
YYYY
Hebrew Name
*
Mother's Hebrew Name
*
Marital Status
*
Single
Married
Divorced
Widowed
Address
*
Street Address
City
State / Province / Region
Zip / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Northern Mariana Islands
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone where you can be reached
*
Email
*
Enter Email
Confirm Email
Do you have any kids?
*
Yes
No
Emergency Contact Name
*
First
Last
Emergency Contact Relation
*
Relationship of Emergency Contact to you
Emergency Contact Phone
*
Highest Grade Completed
*
High School
College
Certificate
Seminary
The school(s) attended
*
Professional Training
*
Current Occupation
*
What is your primary language?
*
What other languages do you speak?
Please upload your recent photo here
Either email it to ilearn@machonchana.org
II. General Information
Why are you interested in learning at iLEARN?
What are you hoping to gain from this program?
Describe your level of Torah skills and knowledge
What subjects would you like to learn and issues to address?
What teachers would you like to hear?
Please tell us any additional information you feel we should know about you and your interest:
III. Jewish Background
Are you Jewish?
*
Yes
No
Describe your level of observance and for how long:
*
Were you adopted?
*
No
Yes
Are you a convert to Judaism?
*
No
Yes
If yes, who was the converting Beth Din?
*
Jewish Contact/Referral #1 Name
*
Rabbi, Shliach, or a head of a Jewish organization that knows you well
Jewish Contact/Referral #2 Name
Rabbi, Shliach, or a head of a Jewish organization that knows you well
Jewish Contact Referral #1 Relation
*
What is your contacts relationship to you?
Jewish Contact Referral #2 Relation
What is your contacts relationship to you?
Jewish Contact/Referral #1 Phone
*
Jewish Contact/Referral #2 Phone
*
Jewish Contact Referral #1 Email
*
Jewish Contact Referral #2 Email
Permission to be included in pictures and videos for promotional purposes.
*
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