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Chabad Teen Network

ב"ה

CTeen U Fall 2023 Registration

Student Application - Jewish Wellness Course
Full Name*
First Name Last Name
Teen E-mail*
Cell Phone Number*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Gender*

MaleFemale
Birth Date*

Month Day Year
Parent E-mail*
Father's Name*
First Name Last Name
Is father Jewish?*
Mother's Name*
First Name Last Name
Is mother Jewish?*
High School*
Grade*

89101112
My high school GPA is
My SAT SCORE is
Please list any Judaic educational programs you participated in *
Extracurricular Activities Please list any activities you participate in and your roles and responsibilities.
What are the three most significant things you want to gain from attending CTeen U?*
Terms of Agreement*

I fully acknowledge that the submission of the online registration form does not necessarily constitute acceptance to the program. All submissions are subject to a review of up to ten business days. CTeen U will only accept teens it deems a proper fit for the program; we reserve the right to reject any applicant whom we deem not to be a good match for this type of program. A full refund will be granted to those denied.
Have you attended a CTeen Summer trip?
Name of teen who referred you
Name of teen whom you referred
Payment
Program Fee*

Full (Course Value): $499 USD + $35 Book FeeStandard Fee (includes 1 Credit): $360 CAD (includes book fee)Subsidized Fee: $180 CAD (includes book fee)
Discount Code Discounts will not show on the total amount below but will be adjusted manually

Payment*

Credit Card Bank Transfer

Postal / Zip Code

Country

Total

$0.00
Attention Grade 10-12 CTeen U Students: In order to receive the university credits, you will need to fill out one more important form after you submit your application. Look out for an email with the link to that form.
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