DIRECTIONS FOR COMPLETING APPLICATION

• Complete all items clearly. 

• Please email or mail a copy of the most current report card. office@chofetzchaimla.org

• Completed forms accompanied by an application/entrance exam fee of $100.00 should be mailed to 1540 S. Robertson Blvd. Los Angeles, California 90035. Or click HERE to pay on this website. 

The admission process includes:

A. Completed application

B. Entrance Exam

C. Personal Interview

Student's Name *
Student's Name
Date of Birth *
Date of Birth
Student's Address *
Student's Address
Student's Home Phone *
Student's Home Phone
Student's Cell Phone
Student's Cell Phone
Father's Name *
Father's Name
Father's Title *
Father's Home Phone *
Father's Home Phone
Father's Cell Phone *
Father's Cell Phone
Father's Business Phone
Father's Business Phone
Father's Business Address
Father's Business Address
Father's Home Address
Father's Home Address
Leave blank if same as Son's address
Mother's Name *
Mother's Name
Title *
Mother's Home Phone *
Mother's Home Phone
Mother's Cell Phone *
Mother's Cell Phone
Mother's Business Address
Mother's Business Address
Mother Home Address
Mother Home Address
If different than son's address
Paternal Grandparent's Address
Paternal Grandparent's Address
Paternal Grandparent's Home Phone
Paternal Grandparent's Home Phone
Maternal Grandparent's Address
Maternal Grandparent's Address
Maternal Grandparent's Home Phone
Maternal Grandparent's Home Phone
Name/Age/Grade/School
Name of School/ Dates of Attendance
Synagogue Rav *
Synagogue Rav
Please provide the following references:
Synagogue Rav Phone Number *
Synagogue Rav Phone Number
8th Grade Rebbe Name *
8th Grade Rebbe Name
8th Grade Rebbe Phone Number *
8th Grade Rebbe Phone Number
Principal's Name *
Principal's Name
Principal's Phone Number *
Principal's Phone Number
Any other reference you would like us to contact?
Date Submitted *
Date Submitted