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User ID
is
First name
contains
is
does not contain
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Last name
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Email
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Phone
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Spouse or partner name (optional)
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Street Address
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City
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State
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ZIP
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is
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Cell Phone
contains
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empty
not empty
begins with
ends with
Home Phone
contains
is
does not contain
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empty
not empty
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ends with
Application Type
is
is not
Sponsoring Rabbi applying for a Conversion Candidate
Sponsoring Rabbi applying for an Affirmation Candidate
Rabbi applying to join the SCCBD as a Dayan
Bet Din Date
on or before
is
on or after
empty
any date
this month
this year
last month
last year
is not
Processes
is
Yes
No
Details on Candidates outside SoCal
is
Yes
No
Hebrew First and Middle Names in Hebrew Characters
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Patronymic / Matronymic
is
is not
אברהם אבינו ושרה אמנו
אברהם ושרה
Other
Other Custom Patronymic / Matronymic (in HEBREW CHARACTERS)
contains
is
does not contain
is not
empty
not empty
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ends with
Hebrew Name in Transliteration
contains
is
does not contain
is not
empty
not empty
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ends with
Candidate's Age
contains
is
does not contain
is not
empty
not empty
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ends with
Sponsoring Rabbi has known Candidate for this amount of time (years / months)
contains
is
does not contain
is not
empty
not empty
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ends with
S/he is a patrilineal Jew raised Jewish?
is
is not
Yes
No
Candidate has been working towards conversion for this amount of time (years / months)
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Candidate's Synagogue or Religious Community (in which they particiapte)
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Candidate is involved there in the following way(s):
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is
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empty
not empty
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ends with
Group participation
any of selected
all of selected
none of selected
Board of Governers
Fundraising Committee
Candidate First Language
contains
is
does not contain
is not
empty
not empty
begins with
ends with
With which races and/or ethnicities does the candidate identify?
contains
is
does not contain
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empty
not empty
begins with
ends with
Candidate Ethnicity: Hispanic or Latino
is
is not
Yes
No
Does the candidate identify as LGBTQ+?
is
is not
Yes
No
N/A (Minor)
Candidate Pronouns
contains
is
does not contain
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empty
not empty
begins with
ends with
Candidate Gender Identity
is
is not
Woman
Man
Other
Candidate Gender Identity (if Other)
contains
is
does not contain
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empty
not empty
begins with
ends with
Does the candidate identify as a person with a visible or invisible disability?
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Rabbinic Endorsement Questions Specific to Adult Candidates
any of selected
all of selected
none of selected
Candidate affirm Jewish Commitment Declaration.
Candidate has been given SCCBD Essay Questions
Candidate has completed a Conversion Curriculum approved by SCCBD
Candidate meets SCCBD requirements for education
Questions for Convert
is
Yes
No
How to use Suggested Topics
is
Yes
No
Hatafat Dam Brit
is
Yes
No
Hatafat Dam Brit Certificate (If Needed)
is
Yes
No
Brit Certificate (If Needed)
is
Yes
No
Endorsement Questions Common to Adult and Minor Candidates (All must be Checked)
any of selected
all of selected
none of selected
Candidate is ready for Conversion
Candidate lives within Southern California
No imminent event (e.g., wedding) requires urgent conversion.
Sponsoring Rabbi agrees to arrive 10 minutes early.
As Sponsoring Rabbi I understand I cannot Chair the Session
Sponsoring Rabbi will participate in the Bet Din session.
Endorsement Questions specific to Minor Candidates
any of selected
all of selected
none of selected
Parents/Guardians discussed with me their child’s religious/cultural upbringing.
Parents/Guardians agree to raise the child as exclusively Jewish
I have written consent from all Parents/Guardians
Minor Specific Endorsement
is
Yes
No
Rules for Minor Candidates
is
Yes
No
Parent / Guardian 1 Full Name
contains
is
does not contain
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empty
not empty
begins with
ends with
Parent / Guardian 2 Full Name (if applicable)
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Was child born by surrogacy? (For Child Candidates Only)
is
is not
Yes
No
Is the child adopted? For Minor Candidates Only
is
is not
Yes
No
Genetically related to parent(s)? For Minor Candidates Only
is
is not
Yes
No
Parental Consent Form
is
Yes
No
Questions for Parents
is
Yes
No
Parental Commitment Text for Daughter by 1 Parent, who is already Jewish
is
Yes
No
Parental Commitment Text for Daughter by 1 Parent, who is also Converting
is
Yes
No
Parental Commitment Text for Son by 1 Parent, who is already Jewish
is
Yes
No
Parental Commitment Text for Son by 1 Parent, who is also Converting
is
Yes
No
Parental Commitment Text for Daughter by 2 Parents, who are already Jewish
is
Yes
No
Parental Commitment Text for Daughter by 2 Parents, who also Converting
is
Yes
No
Parental Commitment Text for Son by 2 Parents, who are already Jewish
is
Yes
No
Parental Commitment Text for Son by 2 Parents, who also Converting
is
Yes
No
Today's Date
on or before
is
on or after
empty
any date
this month
this year
last month
last year
is not
Sponsoring Rabbi's Consent
is
is not
Yes
No
Sponsoring Rabbi's Name
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Sponsoring Rabbi's Email
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Sponsoring Rabbi's Phone Number
contains
is
does not contain
is not
empty
not empty
begins with
ends with
I am a (Check all that Apply)
any of selected
all of selected
none of selected
Congregational Rabbi (please define below)
Community Rabbi
Chaplain (please define below)
Academic
Educator
Retired
Other (please define below)
Congregational Rabbi (Name and address of synagogue)
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Chaplain (Name and address of employer)
contains
is
does not contain
is not
empty
not empty
begins with
ends with
If Other
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Ordaining Institution
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Year of Ordination
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Rabbinical Association Membership(s)
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Job Title
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Employer
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Web Site
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Denomination
is
is not
Reform
Conservative
Reconstructionist
Transdenominational
Renewal
Reform,Transdenominational
Reform, Reconstructionist
Affiliation
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Specialty
is
is not
Chaplain
Writer/MFT
10/24/2017
Also hospice
"Jewish Experience Center"
Business Phone
contains
is
does not contain
is not
empty
not empty
begins with
ends with
Area
any of selected
all of selected
none of selected
AJU
Downtown
East LA
West LA
Fullerton
Mid-Wishire
O.C.
Palm Springs
Riverside
S. Barb.
San Bernardino
San Luis Obispo
So. Bay
Valley
Ventura
Out of Area
Trained
on or before
is
on or after
empty
any date
this month
this year
last month
last year
is not
I am current member in Bd. of Rabbis of SoCal
is
is not
Yes
No
Letter of Agreement Terms
is
Yes
No
Member in good standing of (at least one is required):
any of selected
all of selected
none of selected
AARSHC
AJRCAA
CCAR
IRC
RA
RCA
RRA
Renewal
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