Chuppah v'Kiddushin Registration

Name

Email address

Telephone no.

Full Hebrew Name (please type in Hebrew)

Father's full Hebrew name (please type in Hebrew)

Mother's full Hebrew name (please type in Hebrew)

Birthdate

Address (include city, state, zip, country)

Family Status

Select all that apply: What is the extent of your Torah education?

Independent learning High school Yeshiva Kolel Smicha Shlichus Rabbonus Dayanus

Tell us a little about yourself:

How well can you independently learn Shulchan Aruch?

Rabbi who can serve as your reference:

Relationship to your reference?

Reference phone no.

I accept the Machon Smicha Application Terms and Conditions (see below)

Yes

I affirm that, to the best of my knowledge, all the information provided above is true

Yes

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