Please fill out the following form to let us know a little bit about your family and your potential CHA students.
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Full Name*
Street*
City, State Zip*
Email Address*
Phone Number*	Day    Alternate
Name of student	Gender Male Female
Date of Birth	(mm/dd/yyyy)
Grade interested	Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
Name of student	Gender Male Female
Date of Birth
How did you hear about CHA? Please check all that apply.	Hillel Family, if so who?        We are a current CHA Family   We are a former CHA Family   JCC Member   Temple or Synagogue    Hillel Faculty or Staff Member   Preschool   Newspaper/Magazine   Internet   Other:
Student Interests	Sports Music The Arts Other Interests:
Would you like us to include some information about Financial Assistance?  Yes No

Your form will be sent to our Admission Director by clicking on the "Submit" button above.
Please be sure to click the button only once.

Thank you for your interest in Cohen Hillel Academy

Please Note: Questions marked with an asterisk (*) are required.