Application - Chabad Jewish Center of NWBC

Full Name*

First NameLast Name

Birth Date*

MonthDayYear

E-mail*

Phone Number

Area CodePhone Number

Address*

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

High School*

Check all that apply*

I have taken or plan to take the SAT Reasoning test.I have taken or plan to take the ACT exam.I have taken or plan to take AP classesI have taken or plan to take the TOEFL exam.

My HS GPA is:*

My SAT SCORE is:*

Extra-curricular Activities*Please list any activities you participate in and your roles and responsibilities.

Jewish Education*Please list any Jewish educational programs you participate/d in

What are the three most significant things you want to gain from attending CTeen U?**

I fully acknowledge that the submission of the online registration form does not necessarily constitute acceptance to the program. All submissions are subject to a review of up to ten business days. CTeen U will only accept teens it deems a proper fit for the program; we reserve the right to reject any applicant whom we deem not to be a good match for this type of program. A full refund will be granted to those denied.

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