Application for Conversion

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

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.


For office use only

Date

Signed


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