Parent Questionnaire-2021-2022

Application for Admission 2021-2022
Parent Questionnaire
Parent E-mail
Where Temima should send receipt of application
Legal Name of Student Applying
Name Used (if different)
Hebrew Name
Birth Date

MonthDayYear
Hebrew Birth Date
Birthplace
Applying for Grade
Social Security Number
Need for standardized tests and scholarships. If you do not have a SSN, just put all zeros
Address

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone

Area CodePhone Number
Please list the name and county of the public high school that services your home address.
Father's Full Name

First NameLast Name
Father's Occupation
Father's E-mail
Father's Work Phone

Area CodePhone Number
Father's Cell Phone

Area CodePhone Number
Mother's Full Name

First NameLast Name
Mother's Occupation
Mother's Email
Mother's Work Phone

Area CodePhone Number
Mother's Cell Phone

Area CodePhone Number
Are parents divorced/separated?
Please also direct correspondence to:

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
E-mail
Are both parents Jewish by birth?
Please explain.
Answers from this form are used to help direct and guide your daughter during her experience at Temima. Please be candid and honest in your responses. All information will be kept confidential.
Please rank the following statements on a scale from 1 to 5, with 1 being the least and 5 being the most.

I support my daughter in her decision to attend Temima High School.

	1	2	3	4	5

1 is Least, 5 is Most

My daughter is capable of taking responsibility for her education.

	1	2	3	4	5

1 is Least, 5 is Most

My daughter is capable of facing and overcoming challenges even when doing so is uncomfortable.

	1	2	3	4	5

1 is Least, 5 is Most

In my estimation, my daughter practices positive thinking.

	1	2	3	4	5

1 is Least, 5 is Most

Please include comments or explanations relevant to your answers above:
Please list any educational or psychological evaluation administered by a psychologist, psychiatrist or counselor, and upload copies of test results or consultation reports with this application. You can also bring copies to the Temima office.
Upload a File

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Is the applicant taking any attention-facilitating, depression, or anxiety medication?
Please name medication(s).
Does your daughter have any learning challenges?
Please explain.
Has your daughter displayed evidence of anxiety or psychological, emotional or mood disorders?
Please explain.
Please list your child’s special areas of interest such as music, drama, sports, community involvement, etc. Indicate if she participates formally in any activities (such as piano lessons, a sports team, etc.), and give an indication of both her dedication to each activity and her intent to continue with it upon entering high school.
What are your expectations of Temima High School?
Why do you believe that Temima High School for Girls will be a good educational environment for your child?
Please write a brief description of your daughter’s religious background and experience.
I have the following comments/concerns regarding my daughter’s enrollment at Temima:
Our parents are an important part of our school. Please let us know if there are any talents, hobbies, or interests that you have that you would like to share with our school.

Please fill out the form below to submit a record request and recommendation forms to your child's CURRENT school. The school will send the records directly to Temima.
School my child is currently attending:

Other
Thank you! The appropriate TDSA staff will receive emails with record requests and evaluation forms for your child. TDSA will then send this information directly to Temima.
Please fill out the fields below to send record requests & recommendation forms to your child's school.
Office E-mail (for record request)
Principal's Name
Principal's E-mail
English Teacher's Name
English Teacher's E-mail
Math Teacher's Name
Math Teacher's E-mail
Chumash Teacher's Name
Chumash Teacher's E-mail
School Address
School Telephone

Payment Page
Please indicate how you would like to pay the $300 application fee:
Pay with PayPal - you will be redirected after the last page of the form is completed. You do not need a PayPal account; simply choose "Pay with a credit or debit card" under the login section.
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Application Fee$300.00

Total $0.00

Application to Temima High School does not guarantee admission.

Please understand that if you apply to Temima you are agreeing to adhere to our educational and financial policies.
I am interested in working with my daughter’s teachers and the school administration to make the best decisions for her personal and academic growth. I understand that this may require investing time in addressing challenges and looking for solutions.
I will familiarize myself with the Temima Parent/Student Handbook and support the rules and regulations therein.
I have read the Temima Profile, and the Application for Admission, and I understand the tuition and fees.
I agree to send record requests & evaluation forms to the school mentioned above.
Parent Name (signing below)
Parent Signature
Date

MonthDayYear
Should be Empty:

Application for Admission 2021-2022