Please read this important document before completing the application.
Why are you opening this file? (Please choose one of the following):
Both spouses are ready to arrange a Get, and we wish to schedule a Get at this time.I am opening a file to send a hazmana (summons) to my spouse for a Get.I am opening a file to send a hazmana (summons) to my spouse for a Get and to resolve all other divorce issues in a din torah arbitration.I want the Beth Din to help me mediate divorce issues between us.I am unsure of the answer to this question, and I wish to speak with someone about my options.
Have you already spoken with someone in the office recently about your case? (Please choose one of the following):
YesNo
Who is submitting this application?WifeHusband
Submitters Email:
Title: —Please choose an option—Dr.Mr.Ms.Mrs.
First Name
Maiden Name
Preferred Last Name
Home or Office Number
Mobile Number
Street Address
City
State
Zip Code
Country (if not U.S.A.)
Email Address
Year of Birth
Place of Birth
Title: —Please choose an option—RabbiDr.Mr.Ms.Mrs.
Last Name
Type of Marriage OrthodoxConservativeReformCivil Marriage OnlyI don't knowOther
Year of Marriage
Number of children from this marriage
Age of youngest child from this marriage
Approximately how long have you been separated? (If you are still living in the same residence, please indicate that you are still residing together; please note that a Get cannot be arranged if the couple still lives together)
Was a halachic prenup signed? YesNoOther
Was wife previously married to anyone else? If so, how did that marriage end?
Is wife a convert? YesNo
Was wife adopted as a child? YesNo
Was husband previously married to anyone else? If so, how did that marriage end?
Civil divorce status
Is husband a convert? YesNo
Was husband adopted as a child? YesNo
Additional comments:
Who will be paying for the Get?:
