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.


    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