AUSTIN JEWISH ACADEMY – APPLICATION FOR ADMISSIONS
7300 Hart Lane, Austin TX 78731
Phone 512.735.8350 FAX 512.735.8351 www.austinjewishacademy.org
Full Name Of Applicant______________________________________________________________ Nickname: ________________
(first) (middle) (last)
Applying for Grade____________Applying for School Year_____________Male Female Date of Birth: _____________
City, State, Country of Birth _______________________________________Primary Language ______________________________
Hebrew Name (include transliteration)_______________________________Hebrew Date of Birth (if known)___________________
Primary Address: ____________________________________________________________________________________________
City: ________________________________________________ State: _______________Zip: _______________________________
Phone: (_____)________________________________________
Receives Report Card Yes No (Check One) Both Parents Mother Father Other
Secondary Address (if applicable) _______________________________________________________________________________
City: ________________________________________________ State: _______________ Zip: ______________________________
Phone: (_____)________________________________________
Receives Report Card Yes No (Check One) Both Parents Mother Father Other
Applicant’s Previous Secular Education
Name of School Dates of Attendance
1.
2.
3.
4.
Applicant’s Previous Jewish Education
Name of School Dates of Attendance
1.
2.
3.
4.
Synagogue Affiliation (if any) _________________________________________________________________________________
If not affiliated with a synagogue, with which of the following does your family most closely identify with?
Orthodox Conservative Reform Reconstructionist Other (please specify)__________________________
Kindly state below the family practice with respect to religious observances such as Shabbat, holidays, dietary laws, etc. Please be as
explicit as possible.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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Parent / Guardian Information
Parents (Check One) Married Separated Divorced Widow/Widower Other ____________________
Party Responsible For Payment (Check One) Father Mother Other ____________________________________
1. Relationship to Applicant: (Check One)
Father Mother Stepfather Stepmother Guardian Other (Please specify)_________________________
Last Name ____________________________________________(Check One) Mr. Mrs. Ms. Dr. Other _______
First Name __________________________________________________________________________________________________
Occupation__________________________________________________________________________________________________
Employer: ______________________________________________ Work Phone (____)____________________________________
Cell Phone/Pager (_____)___________________________________Email_______________________________________________
Educational Background
High School _________________________________________________________________________________________________
College ___________________________________________________ Year Graduated ____________ Major __________________
Graduate School ____________________________________________ Year Graduated ____________ Major __________________
Highest Degree Attained _______________________________________________________________________________________
Current Professional or University Affiliations _____________________________________________________________________
Previous Jewish Education _____________________________________________________________________________________
Current Organizational Affiliations (religious) ______________________________________________________________________
2. Relationship to Applicant: (Check One)
Father Mother Stepfather Stepmother Guardian Other (Please specify)_________________________
Last Name ____________________________________________(Check One) Mr. Mrs. Ms. Dr. Other _______
First Name __________________________________________________________________________________________________
Occupation__________________________________________________________________________________________________
Employer: ______________________________________________ Work Phone (____)____________________________________
Cell Phone/Pager (_____)___________________________________Email_______________________________________________
Educational Background
High School _________________________________________________________________________________________________
College ___________________________________________________ Year Graduated ____________ Major __________________
Graduate School ____________________________________________ Year Graduated ____________ Major __________________
Highest Degree Attained _______________________________________________________________________________________
Current Professional or University Affiliations _____________________________________________________________________
Previous Jewish Education _____________________________________________________________________________________
Current Organizational Affiliations (religious) ______________________________________________________________________
How did the parents obtain information concerning Austin Jewish Academy?
_________________________________________________________________
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Family Information
Siblings:
Name: _______________________ Birth date: ___________ Name: _______________________ Birth date: ___________
Name: _______________________ Birth date: ___________ Name: _______________________ Birth date: ___________
Name: _______________________ Birth date: ___________ Name: _______________________ Birth date: ___________
Does your family have any other relatives who currently attend or previously attended AJA? If so, list below.
Child’s Name Relationship Year(s) of Attendance
Grandparent Mailing List Data (skip this part if deceased):
Paternal Grandparent(s) ____________________________________________________________________________________
Address _____________________________________________________________________ Phone (_____)_______________
Maternal Grandparent(s) ___________________________________________________________________________________
Address _____________________________________________________________________ Phone (_____)_______________
Application fees are non-refundable. A limited amount of Tuition Assistance is available to qualified applicants. Please
contact the Business Office if you desire a Tuition Assistance application packet.
All the information in this application is true, complete, and correct. I understand that the admissions packet is not complete until this
Application, the Confidential Teacher Questionaire, transcripts and student records from previous schools, requested testing, and a
non-refundable check for the $100 Application Fee have been received by Austin Jewish Academy. I understand that no action will be
taken on this Application until the packet is complete.
_____________________________________________________________________ _________________________
Signature of Parent or Legal Guardian Date
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Signature of Parent or Legal Guardian Date