Admissions Child's Name(Required) First Last Child's Hebrew Name Child's Date of Birth(Required) Month Day Year Home Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone Number(Required)Father's Name Father's CellFather's Email Mother's Name Mother's CellMother's Email Current School Current Grade Teacher(s) Name(s) Is your child receiving any related services? Yes No If Yes, Please Check Speech and Language PT OT Counseling SETTS/Resource Room Please list all schools and grades your child has attended previouslyShul Affiliation Rabbi's Name ListSibling's NameAgeSchool Add RemoveHow did you hear about CAHAL?Have you previously applied to CAHAL? No Yes Briefly describe your childYour child's interest:Your child's challenges:Extracurricular activities:Please list any academic supports outside of school:Confirmation Email(Required) How would you like to pay the $100 application fee? Credit Card/Paypal Zelle Total CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ Download Print Version of the Application Download CAHAL 540-A Willow AvenueCedarhurst, NY 11516 Phone (516) 295-3666 Fax (516) 295-2899 Email CAHAL@cahal.org
