ADMISSIONS

Thank you for your interest in the United Hebrew Institute. You can access our admission forms online or you can request an admission brochure by calling us at 570-287-9600.

Feel free to call me anytime with questions or to request a tour of the school.

Best regards,

Rabbi Nemetsky

Application for Admission
* Required Fields
*Email Address:
I. *Family Name:		*Home Phone:
Address:		City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip Code:
II. NAMES OF CHILDREN FOR ENROLLMENT English Name (First, Middle) Hebrew Name (First, Middle) Date of Birth (mm/dd/yr) Age Grade Entering
IIA. Special Needs or Health Concerns the school should be aware of:(including medications taken daily)
III. Father's Name:		Hebrew Name:
Occupation:
Daytime Phone:		Cell Phone:
IV. Mother's Name:		Hebrew Name:
Mother's Maiden Name:
Occupation:
Daytime Phone:		Cell Phone:
V. Synagogue Affiliation:
VI. Legal Guardian (If Separated or Divorced):
Address additional mail should be sent to:
Address:		City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip Code:
VII. School last Attended:
VIII. Name and Addresses of Living Grandparents:
Maternal:
Address:		City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip Code:
Paternal:
Address:		City:
State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY	Zip Code:
NONDISCRIMINATORY POLICY
The United Hebrew Institute admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to the students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, scholarship and loan programs, and athletic and other school administered programs.