Identification Insert photo here Family name Given name Middle name Maiden name Marital status Address Apt. City Postal code E-mail address Home tel Cell Date of birth Place of birth Education Education Degree/Certificate Institution Date of Education Employment History Place of current employment Position Number of years at this employment Employer’s name Employer’s telephone Previous employer Number of years worked Family information and other relations 1.Father Name Place of birth Is still living Age Occupation Religion Marital status 2.Mother Name Place of birth Is still living Age Occupation Religion Marital status 3.Sibling Information Name of siblings 4.Other Relationships Have you ever been married Do you have any children (If you answered yes to this question, please fill in the chart on the next page) Name of child Age Resides with you Visits you Do you have any personal and meaningful relationships with a person of the Jewish faith? If yes, please SEND him/her this LINK to a questionnaire which needs to be filled out and and sent back to us. Questions Please answer all questions as fully as you can. You may write on the back of these sheets if necessary. 1.Describe your religious background and your parent’s lifestyle. 2.What has been your religious education to date? 3.How long have you considered conversion to Judaism and what has prompted this interest? 4.What has been your Jewish experiences to date? 5.Please list any Judaic reading you have read by title, author, publisher, and/or any formal Judaic classes you have attended. 6.Do you have any medical problem? If yes, please explain. 7.Are you taking any medications? If yes, which medication? 8.Are you presently under the care of a doctor and/or therapist? If yes, please explain why. 9.Is there, or has there been any serious medical illness (physical or mental) in your family? 10.Do you have a sponsoring Orthodox Rabbi? If yes, please provide us his name, address and telephone number. 11.Please provide us with names, addresses and telephone number of two references: . 1.Name Telephone Address Relationship 2.Name Telephone Address Relationship I have fully read and filled out this application for conversion to the best of my ability. Applicant’s signature Date when form completed Partner’s signature Date If not applicable, please check here: This application must be accompanied by a non-refundableapplication fee of $250.00. Once this application fee has been received, an appointment will be set up for you to meet with the Rabbinical Court for Conversion. Questionnaire B (For the Jewish partner) Identification Family name Given name Place of birth Date of birth Address Apt. City Postal code E-mail address Home tel Cell Employment History Place of current employment Position Number of years at this employment Employer’s name Employer’s telephone Personal Information Marital Status Do you have any children? If so, pleaselist their ages Born Jewish If not, which Rabbi has converted you? Father Is father a Cohen, Levy or Israelite? Is father alive Father’s occupation Father’s marital status Mother Mother’s names (Family, Maiden, Given) Was your mother born to a Jewish mother? If not, converted by which Rabbi? Was mother adopted? Mother’s Hebrew name Is mother alive Mother’s marital status Questions 1.Describe your formal and/or informal Jewish Education. 2.How long have you known your non-Jewish partner? 3.Are your parents awareof this relationship? 4.Are you prepared to attend classes and participate completely in this process? Date Signed
