CONGREGATION BETH SHOLOM OF LAWRENCE
YOUNG ISRAEL OF LAWRENCE-CEDARHURST
YOUNG ISRAEL OF WOODMERE

SHIDDUCH APPLICATION FORM

Presenter's Name:    Presenter's Phone:  

APPLICANT INFORMATION

First Name: Last Name:  
Gender: Male    Female
Street Address
Address (cont.)
City
State
Zip
Telephone: (Home) (Cell):  
Email:
Date of Birth:
Height:

Indicate your highest level of secular education:
Current occupation:
Indicate your highest level of Judaic education:
Please Tell Us The Schools You Have Attended:
Elementary School(s):
High School(s):
Israel Yeshiva(s):
College(s):
Are you a Sabbath observer? Yes  No
Do you observe kosher dietary laws? Yes  No


Marital information:
If divorced, please provide the name and telephone number of the Rabbi who facilitated the GET.
In addition, please indicate the name of the Beit Din which issued the GET.
Name of Rabbi: Telephone:  
Name of Beit Din:

Do you have children? Yes   No
Do any of these children live with you? Yes   No


Are you:
What is your body type?:
What is your religious affiliation?
(Hold the ctrl key to select multiple)
What shul do you attend?
Who is your rabbi?
Are you a baal(lat) teshuvah? Yes  No
Are you a jew from birth? Yes  No



Interests:
What do you enjoy doing in your spare time?
Do you smoke? Yes  No
Would you date an individual who smokes? Yes  No
Do you attend movies? Yes  No
Do you watch television? Yes  No
Please indicate the qualities which best describe you:
Please indicate the qualities that you seek in a spouse:

What is the age range of the individual which you hope to meet?
(Hold down the control key to select multiple age ranges.)
Education of individual that you will meet:
Preferences of marital status of the individual that you will meet:
Would you be willing to be introduced to an individual with children? Yes  No
Would you be willing to come to an event? Yes  No
Are you willing to relocate? Yes  No
Are you willing to make aliyah? Yes  No
Additional Notes: