Tefillin Bank Student Application
Congratulations on your commitment to owning and using a pair of Tefillin regularly! Please fill out the form below to request a grant from the Tefillin Bank at Chabad on Campus to help pay for your new Tefillin. Thank you!
Full Name
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First Name
Last Name
E-mail
*
Date of Birth
*
-
Month
-
Day
Year
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Phone Number
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-
Area Code
Phone Number
Hebrew name:
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Mother's Hebrew name:
*
School currently attending:
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Chabad Rabbi's Name
*
First Name
Last Name
Which of your parents are Jewish?
*
Both
Mother
Father
None
Are there any conversions in your family?
Yes
No
If yes, who converted?
Which was the converting Bet Din (Rabbinical Court)?
Do you currently own a Kosher pair of Tefillin?
*
Yes
No
If you receive a monetary grant towards the purchase of a pair of Tefillin, how often will you commit to wearing them?
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Daily
Sundays
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Please explain why you are applying for this grant in a few sentences or more:
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By accepting this grant from the Chabad on Campus Tefillin Bank, I commit to lay Tefillin according to the frequency listed above.
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Yes
Date
*
-
Month
-
Day
Year
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Signature (Please use your mouse cursor or finger on smart device to sign)
*
Submit
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