Application for Conversion :: RCC | Rabbinical Council of California

I. Personal Data:

Last Name

First Name

Middle Name(if applicable)

Maiden Name (If applicable)

Street Address

City

State

Zipcode

Home Phone

Work Phone

Cell Phone

Age

Date of Birth

Place of Birth

Marital Status

Name of Spouse (if applicable)

Religion

If you have had other marriages, please provide more information:

Names of Children:

Please List Last name, first name and age

Employment

Current Occupation

Place of Employment

Working there since

Position

Previoust Occupation(s)

Place(s) of employment

Date(s)

Position(s)

Describe your work experiences, likes, and dislikes

II. Family Background

Father

Name

Age

occupation

marital status

Religion

Mother

Name

age

occupation

marital status

Religion

What is your relationship with your father?

How has he influenced your life?

What is your relationship with your mother?

How has she influenced your life?

Names and ages of parents' children (Applicant's siblings):

What is the extent of your parents' religious observance, affiliations, activities?

What is your current relationship with your family?

III. Education

names of Institution(s) degree/certificate date

What religious education did you receive?

How much of an interested did you take in religion over the years?

Describe your experience of high school

Detail your educational experiences since high school: academic likes and dislikes, relationships with teachers, fellow students, etc.

IV. General

Present Religion

Previous religious experiences (please detail all churches or synagogues you have attended)

Non-academic expereiences, activities:

Travel to Israel(detail your thoughts and impressions)

V. Medical History

State of Health

Date of last complete physical examination

Medication being taken, if any

Are you currently under the care of a doctor?

If so, please explain the reason.

Have you ever been to a therapist?

If so, please explain the reason:

Have you expereinced any serious medical condition(s)?

If so, please explain the reason:

Any serious illness in your family?

If so, please explain:

VI. Conversion

Please explain, in detail, the reasons you are considering conversion.

How long have you been considering conversion?

What is your knowledge of Judaism?

Please list books you have read or classes you have taken on Judaism.

Do you have any relationships with persons of the Jewish faith? Are you married to or considering marriage to a Jewish person?

Describe your philosophy of life.

VII. References

Do you have a sponsoring Rabbi?

Sponsoring Rabbi Name

Sponsoring Rabbi Address

Sponsoring Rabbi Phone

You are also required to provide 2 personal references

Reference Name

Reference Address

Reference Phone

Relationship to this Reference

Reference Name

Reference Address

Reference Phone

Relationship to this Reference

General Comments

This is where you can provide us with any other information you feel is important.

There is a non-refundable application fee of $295.00

Method of payment for application fee:

Credit Card
Check

You will also need to mail 2 passport size photos of yourself. Please mail these photos to

Rabbinical Council of California
3780 Wilshire Blvd. #420
Los Angeles, CA 90010