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Hebrew Ulpan - Application form

Hebrew Ulpan - Application form

Student Information

Last Name: First Name:

Hebrew Name:

Date of Birth: Male Female

Phone number:

Alternate phone number:

Email address:


City: Zip Code:

How did you hear about us:

Do you have previous Jewish Education Yes No
If yes, please describe:

Any considerations or difficulties the ulpan should be aware of? (Confidential):


Chabad Ulpan Ivrit Tuition Agreement-

The following is a tuition agreement for the Chabad Ulpan Ivrit. The agreement explains the tuition fees, payments plans and refund policies. Please read it through carefully. If paying by check or cash, full payment must be submitted to the Ulpan office before any student will be permitted to attend classes.

The tuition for the Chabad Ulpan Ivrit is $300.00 per Semester per person (this includes 10 classes, material and registration fee). Membership Not Required .

Discounts: There is a 10% discount off your tuition per semester for each student you successfully introduce a new student to the Ulpan class.

There is a 5% discount for returning students.

You may choose from the following payment methods:
PLAN A: You may pay the entire amount of $300 in full with a check, cash or credit card.

PLAN B: You may use your credit card to pay the tuition on a monthly basis. Your credit card will be billed $100 for the first month and $100.00 for the next 2 months, February and March. To do so please include your credit card number, expiration date and security code.

*If you need to break up your credit card payment, please contact the office to set up an auto payment- 404-252-9508.

There will be no refund for missing classes on a non vacation days, the teacher will make a copy of all class and home work materials for the student and will be happy to assist him/her with any question over the phone or email.

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Your FULL name here:

Credit Card Payment Information:

First Name*

Last Name*

Address Line 1*

Address Line 2

City* State*

Post Code*



Email *

This is my home business address.


Card Type*

Card Number*

Expiration Date*

CVV Security Code*

*If you need to break up your credit card payment, please contact the office to set up an auto payment- 404-252-9508.

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