Temple Emanuel Education Program Enrollment Form

Parent/Guardian 1 Information

Name(Required)

First Last

Email(Required)

Cell Phone(Required)

Home Phone

Work Phone

Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2 Information

Name

First Last

Cell Phone

Home Phone

Work Phone

Address (if different)

Street Address Address Line 2 City State ZIP Code

Student Name(Required)

You will be able to add additional students further down the form

First Last

Grade as of September 2024(Required)

Please upload a recent photo of your child(Required)

Max. file size: 512 MB.

Attending Jewish summer camp in Summer of 2024? If so, which one?(Required)

Please enroll student in:(Required)

K’tonton Pre-K program (1 Sunday a month)

Temple Emanuel Religious School, grades K-1 (Sundays only)

Temple Emanuel Religious School, grades 2-6 (Sundays and Thursdays)

Chai385, grades 7-8 (Sundays and Thursdays)

Kesher Newton Afterschool Program, grades K-5 (Mondays and Wednesdays)

Kesher Middle School, grades 6-8 (Wednesdays only)

Kesher Middle School Hebrew Ulpan (Mondays only)

Please select all that apply :(Required)

Child’s mother/s is/are Jewish

Child’s father/s is/are Jewish

Child had brit milah/baby naming ceremony as an infant

Child converted to Judaism

Child will be converting to Judaism

Other

Will your child be participating in the after school care/early drop-off program?(Required)

Arrival at TE between 3:00-3:45 PM on Thursdays

Yes

Kesher Add-ons:(Required)

Early release Wednesdays for Newton Every Wednesday, 12:30pm drop

Early release Wednesdays for Needham Every other Wednesday, 12:30pm drop-off

Early release Wednesdays for Waltham 9 Wednesdays1:20pm drop-off

Early release Wednesdays for Brookline 4 Wednesdays, 12:30pm drop-off

N/A

My child is interested in:(Required)

Children’s Choir

Onot Aviv: Grade 3-5 Israeli Dance Troupe

N/A

My child is interested in:(Required)

Onot Kayitz: Grades 6-12 Israeli Dance Troupe

N/A

Sign my child up for the Ward Elementary School walking group(Required)

Yes

Is your child a returning Kesher student?(Required)

Yes

Is your child a returning Religious School student?(Required)

Yes

Date of Birth(Required)

Child's Pronouns

Child’s Hebrew Name(Required)

Please enter N/A if your child does not yet have a Hebrew Name

Child's secular school(Required)

Child’s email address*(Required)

*5th graders will use their email addresses to communicate with their pen pals in Haifa. Our youth staff will keep your child posted about Synagogue events.

Child’s cell phone number

Previous Jewish Education your child attended at another synagogue or day school? If so, which one?(Required)

Please take your best guess about your child’s Hebrew level

Knows names and sounds of most Hebrew letters, but is not yet reading

Knows sounds of most Hebrew vowels

Can read Hebrew

Has not studied Hebrew before, needs to start from the beginning

Other

Please describe:(Required)

In what other parts of our Jewish community do you participate? (ie. other Synagogues, programs, etc.)(Required)

Are there any changes since September 2023 to any of the following? If so, please specify the changes in space provided and upload any supporting documents (such as updated IEP)

Please check all that apply

Address

Parent/Guardian Emails

Student Emails

Parent/Guardian Cell Phones

Secular School

Jewish Summer Camp

Other

New Address(Required)

Street Address Address Line 2 City State ZIP Code

New parent/guardian email(s)(Required)

New student email(s)(Required)

New parent/guardian cell phone(s)(Required)

New secular school and town it's located in(Required)

Other(Required)

Supporting document(s)

Max. file size: 512 MB.

Safety Information

Child's Weight(Required)

Child's Height(Required)

Child's Hair Color(Required)

Child's Skin Tone(Required)

Child's Eye Color(Required)

Other Identifying Marks(Required)

Friends and Family Email List

(Someone other than parent/guardian who should receive invitations to special events). Press + to add multiple entries.

Full Name

Medical Information

Does your child have any physical limitations?(Required)

Yes

Please elaborate:(Required)

Does your child take medications on a regular basis?(Required)

Yes

If yes, which medications?(Required)

Does your child have allergies on a regular basis?(Required)

Yes

Allergy Information(Required)

Press the + symbol on the right to add information for multiple allergies

Allergic To

Reaction

Treatment

Does your child require to have an epipen on hand?(Required)

Yes

I understand that we must provide an epipen that is not past its expiration date, to store in the Education Program office beginning the first day of school. This is even if student carries one on their person as well.(Required)

Yes

Does your child have any additional dietary restrictions or sensitivities?(Required)

Yes

Please elaborate:(Required)

Does the school your child attends have physical exams and immunizations records on file?(Required)

Yes

Signature/ Initials(Required)

Date(Required)

Class Placement Policy Information

Would you like to provide input for your child's Class Placement?(Required)

Our objective is for every student to be successful in a supportive and engaging educational setting. Class placement is thoughtfully considered, taking into account: • Class size and gender balance • Academic strengths and learning styles • Peer relationships • Individual learning needs. Parents may use the space below to offer input regarding class placement, such as learning style and a brief list of peers who would enhance their school experience. Final decision on class placement will be made by the K-8 Education Director.

Yes

Class Placement Comments and Additional Information

Learning Support Information

Please describe how your child learns best(Required)

What are your child’s strengths, interests and hobbies?(Required)

Does your child have any learning challenges that may impact their learning?(Required)

Yes

Please describe and share any support plans in place at school or at home(Required)

Does your child have an IEP or 504 plan? Please upload a copy here

Max. file size: 512 MB.

Does your child receive individual support services in the classroom at secular school?(Required)

Yes

If yes, please describe(Required)

I give permission for education staff to communicate with my child’s secular school teacher to share strategies for supporting my child’s learning.(Required)

Yes

Signature/ Initials(Required)

Date(Required)

Add another student?(Required)

Yes

Student Name(Required)

You will be able to add an additional student further down the form

First Last

Grade as of September 2024(Required)

Please upload a recent photo of your child(Required)

Max. file size: 512 MB.

Attending Jewish summer camp in Summer of 2024? If so, which one?(Required)

Please enroll student in:(Required)

K’tonton Pre-K program (1 Sunday a month)

Temple Emanuel Religious School, grades K-1 (Sundays only)

Temple Emanuel Religious School, grades 2-6 (Sundays and Thursdays)

Chai385, grades 7-8 (Sundays and Thursdays)

Kesher Newton Afterschool Program, grades K-5 (Mondays and Wednesdays)

Kesher Middle School, grades 6-8 (Wednesdays only)

Kesher Middle School Hebrew Ulpan (Mondays only)

Please select all that apply :(Required)

Child’s mother/s is/are Jewish

Child’s father/s is/are Jewish

Child had brit milah/baby naming ceremony as an infant

Child converted to Judaism

Child will be converting to Judaism

Other

Will your child be participating in the after school care/early drop-off program?(Required)

Arrival at TE between 3:00-3:45 PM on Thursdays

Yes

Kesher Add-ons:(Required)

Early release Wednesdays for Newton Every Wednesday, 12:30pm drop

Early release Wednesdays for Needham Every other Wednesday, 12:30pm drop-off

Early release Wednesdays for Waltham 9 Wednesdays1:20pm drop-off

Early release Wednesdays for Brookline 4 Wednesdays, 12:30pm drop-off

N/A

My child is interested in:(Required)

Children’s Choir

Onot Aviv: Grade 3-5 Israeli Dance Troupe

N/A

My child is interested in:(Required)

Onot Kayitz: Grades 6-12 Israeli Dance Troupe

N/A

Sign my child up for the Ward Elementary School walking group(Required)

Yes

Is your child a returning Kesher student?(Required)

Yes

Is your child a returning Religious School student?(Required)

Yes

Please describe:(Required)

Date of Birth(Required)

Child's Pronouns

Child’s Hebrew Name(Required)

Please enter N/A if your child does not yet have a Hebrew Name

Child's secular school(Required)

Child’s email address*(Required)

*5th graders will use their email addresses to communicate with their pen pals in Haifa. Our youth staff will keep your child posted about Synagogue events.

Child’s cell phone number

Previous Jewish Education your child attended at another synagogue or day school? If so, which one?(Required)

Please take your best guess about your child’s Hebrew level

Knows names and sounds of most Hebrew letters, but is not yet reading

Knows sounds of most Hebrew vowels

Can read Hebrew

Has not studied Hebrew before, needs to start from the beginning

Other

In what other parts of our Jewish community do you participate? (ie. other Synagogues, programs, etc.)(Required)

Are there any changes since September 2023 to any of the following? If so, please specify the changes in space provided and upload any supporting documents (such as updated IEP)

Please check all that apply

Address

Parent/Guardian Emails

Student Emails

Parent/Guardian Cell Phones

Secular School

Jewish Summer Camp

Other

New Address(Required)

Street Address Address Line 2 City State ZIP Code

New parent/guardian Email(s)(Required)

New student email(s)(Required)

New parent/guardian cell phone(s)(Required)

New secular school and town it's located in(Required)

Other(Required)

Supporting Document(s)

Max. file size: 512 MB.

Safety Information

Child's Weight(Required)

Child's Height(Required)

Child's Hair Color(Required)

Child's Skin Tone(Required)

Child's Eye Color(Required)

Other Identifying Marks(Required)

Medical Information

Does your child have any physical limitations?(Required)

Yes

Please elaborate:(Required)

Does your child take medications on a regular basis?(Required)

Yes

If yes, which medications?(Required)

Does your child have allergies on a regular basis?(Required)

Yes

Allergy Information(Required)

Press the + symbol on the right to add information for multiple allergies

Allergic To

Reaction

Treatment

Does your child require to have an epipen on hand?(Required)

Yes

Does your child have any additional dietary restrictions or sensitivities?(Required)

Yes

Please Elaborate:(Required)

Does the school your child attends have physical exam and immunization records on file?(Required)

Yes

Signature/ Initials(Required)

Date

Class Placement Policy Information

Would you like to provide input for your child's Class Placement?(Required)

Yes

Class Placement Comments and Additional Information

Learning Support Information

Please describe how your child learns best(Required)

What are your child’s strengths, interests and hobbies?(Required)

Does your child have any learning challenges that may impact their learning?(Required)

Yes

Please describe and share any support plans in place at school or at home(Required)

Does your child have an IEP or 504 plan? Please upload a copy here

Max. file size: 512 MB.

Does your child receive individual support services in the classroom at secular school?(Required)

Yes

If yes, please describe(Required)

I give permission for education staff to communicate with my child’s secular school teacher to share strategies for supporting my child’s learning.(Required)

Yes

Signature/ Initials(Required)

Date(Required)

Add another student?(Required)

Yes

Student Name(Required)

First Last

Grade as of September 2024(Required)

Please upload a recent photo of your child(Required)

Max. file size: 512 MB.

Attending Jewish summer camp in Summer of 2024? If so, which one?(Required)

Please enroll student in:(Required)

K’tonton Pre-K program (1 Sunday a month)

Temple Emanuel Religious School, grades K-1 (Sundays only)

Temple Emanuel Religious School, grades 2-6 (Sundays and Thursdays)

Chai385, grades 7-8 (Sundays and Thursdays)

Kesher Newton Afterschool Program, grades K-5 (Mondays and Wednesdays)

Kesher Middle School, grades 6-8 (Wednesdays only)

Kesher Middle School Hebrew Ulpan (Mondays only)

Please select all that apply :(Required)

Child’s mother/s is/are Jewish

Child’s father/s is/are Jewish

Child had brit milah/baby naming ceremony as an infant

Child converted to Judaism

Child will be converting to Judaism

Other

Will your child be participating in the after school care/early drop-off program?(Required)

Arrival at TE between 3:00-3:45 PM on Thursdays

Yes

Kesher Add-ons:(Required)

Early release Wednesdays for Newton Every Wednesday, 12:30pm drop

Early release Wednesdays for Needham Every other Wednesday, 12:30pm drop-off

Early release Wednesdays for Waltham 9 Wednesdays1:20pm drop-off

Early release Wednesdays for Brookline 4 Wednesdays, 12:30pm drop-off

N/A

My child is interested in:(Required)

Children’s Choir

Onot Aviv: Grade 3-5 Israeli Dance Troupe

N/A

My child is interested in:(Required)

Onot Kayitz: Grades 6-12 Israeli Dance Troupe

N/A

Sign my child up for the Ward Elementary School walking group(Required)

Yes

Is your child a returning Kesher student?(Required)

Yes

Is your child a returning Religious School student?(Required)

Yes

Please describe:(Required)

Date of Birth(Required)

Child’s Pronouns

Child’s Hebrew Name(Required)

Please enter N/A if your child does not yet have a Hebrew Name

Child's secular school(Required)

Child’s email address*(Required)

*5th graders will use their email addresses to communicate with their pen pals in Haifa. Our youth staff will keep your child posted about Synagogue events.

Child’s cell phone number

Previous Jewish Education your child attended at another synagogue or day school? If so, which one?(Required)

Please take your best guess about your child’s Hebrew level

Knows names and sounds of most Hebrew letters, but is not yet reading

Knows sounds of most Hebrew vowels

Can read Hebrew

Has not studied Hebrew before, needs to start from the beginning

Other

In what other parts of our Jewish community do you participate? (ie. other Synagogues, programs, etc.)(Required)

Are there any changes since September 2023 to any of the following? If so, please specify the changes in space provided and upload any supporting documents (such as updated IEP)

Please check all that apply

Address

Parent/Guardian Emails

Student Emails

Parent/Guardian Cell Phones

Secular School

Jewish Summer Camp

Other

New Address(Required)

Street Address Address Line 2 City State ZIP Code

New parent/guardian email(s)(Required)

New student email(s)(Required)

New parent/guardian cell phone(s)(Required)

New secular school and town it's located in(Required)

Other(Required)

Supporting Document(s)

Max. file size: 512 MB.

Safety Information

Child's Weight(Required)

Child's Height(Required)

Child's Hair Color(Required)

Child's Skin Tone(Required)

Child's Eye Color(Required)

Other Identifying Marks(Required)

Medical Information

Does your child have any physical limitations?(Required)

Yes

Please Elaborate:(Required)

Does your child take medications on a regular basis?(Required)

Yes

If yes, which medications?(Required)

Does your child have allergies on a regular basis?(Required)

Yes

Allergy Information(Required)

Press the + symbol on the right to add information for multiple allergies

Allergic To

Reaction

Treatment

Does your child require to have an epipen on hand?(Required)

Yes

Does your child have any additional dietary restrictions or sensitivities?(Required)

Yes

Please Elaborate:(Required)

Does the school your child attends have physical exam and immunization records on file?(Required)

Yes

Signature/ Initials(Required)

Date(Required)

Class Placement Policy Information

Would you like to provide input for your child's Class Placement?(Required)

Yes

Class Placement Comments and Additional Information

Learning Support Information

Please describe how your child learns best(Required)

What are your child’s strengths, interests and hobbies?(Required)

Does your child have any learning challenges that may impact their learning?(Required)

Yes

Please describe and share any support plans in place at school or at home(Required)

Does your child have an IEP or 504 plan? Please upload a copy here

Max. file size: 512 MB.

Does your child receive individual support services in the classroom at secular school?(Required)

Yes

If yes, please describe(Required)

I give permission for education staff to communicate with my child’s secular school teacher to share strategies for supporting my child’s learning.(Required)

Yes

Signature/ Initials(Required)

Date(Required)

Are any other languages spoken at home? If so, which ones?

Family Information

Names and ages of all children in the family(Required)

Describe your family members' familiarity/ proficiency in Hebrew (written and spoken):

Describe your Jewish life at home:

Is your family a member of Temple Emanuel?(Required)

Yes

What Jewish communities are you/ have you been affiliated with in addition to Temple Emanuel/Kesher?

Other family information you would like to share:

Emergency Information

IN CASE OF EMERGENCY:(Required)

I give permission to Temple Emanuel/Kesher staff members to take any necessary action, such as releasing my child(ren) to one of the emergency contacts listed, administering treatment to my child(ren), including allergy medications I have given the school for this purpose, or arranging transport for my child(ren) to the nearest hospital to receive appropriate emergency care.

Yes

Signature/ Initials(Required)

Date(Required)

Child(ren)’s Physician(Required)

Physician Phone(Required)

Health Insurance Provider and Policy #(Required)

Emergency Contact 1(Required)

OTHER THAN parents/guardians

Full Name

Phone

Relationship to child(ren)

Emergency Contact 2(Required)

OTHER THAN parents/guardians

Full Name

Phone

Relationship to child(ren)

Transportation

Due to a driver shortage, it has been difficult to be able to provide affordable transportation options. However, we are still doing our research to see if we can make something work. Are you interested in transportation to Kesher for an extra cost?(Required)

Yes

How will your child(ren) be arriving to school?(Required)

My child(ren) will walk over from their school*

My child(ren) will be dropped off by a third party (ie. Newton public school transportation)*

My child(ren) will be dropped off by parent/guardian, designated caretaker (ie. babysitter) or a carpool.

*I understand that if my child will be absent from Religious School, I will notify the office on the same day. Children who are walking from school or using 3rd party transportation who do not arrive at the usual time, will receive a family phone call to make sure they are safe.(Required)

Yes

How will your child(ren) be picked up?(Required)

I give permission for my child(ren) to walk home upon dismissal(Required)

Yes

Other caretakers (nanny, babysitter, grandparents) who have permission to pick up your child?

Full Name

Phone Number

I agree to adhere to Temple Emanuel/Kesher's transportation policy and procedures as outlined in the Parent/Guardian Handbook(Required)

Yes

Signature/ Initials(Required)

Date(Required)

Releases

Images(Required)

I give permission for my child's/children’s image/likeness to be used in any school or community-related publications including the Temple Emanuel/Kesher website and Facebook page (no names are listed).

Yes

Contact Information(Required)

I give my permission for my name, address, telephone number, and e-mail address to be given to other families with children at Temple Emanuel/Kesher.

Yes

Free Play(Required)

I give permission for my child/ren to be taken outside of the building for free play.

Yes

Field Trip(Required)

I give permission for my child/children to attend off-site field trips with their class, accompanied by Temple Emanuel/Kesher teachers/staff/parent chaperones. I understand that dates, times and locations will be announced prior to each trip. Students may walk to a local destination or be transported by hired bus, departing from and returning to Temple Emanuel.

Yes

Other Information

Would you be interested in being a “Room Connector” for your grade? Come in and teach a special lesson or read a story? Tutor Hebrew? Help set up for a program?(Required)

Yes

If yes, please describe below. Thank you in advance!(Required)

Financial Assistance: Do you anticipate needing tuition scholarship assistance?(Required)

If yes, please contact the Religious School Office or Main Office for an Abatement Certification form, complete it and return it to the Temple Emanuel office, c/o Tim Mahoney, President (tmahoney@templeemanuel.com). You will be contacted confidentially.

Yes

Any other notes you would like to share with us?

CAPTCHA

Signature/ Initials(Required)

Date(Required)

Kesher Contract

TUITION
Tuition is billed in two equal installments in August and January. Each semester's tuition (or your first monthly payment) is due prior to the start of that semester in order for your child/ren to attend. Processing fees will be charged for all electronic methods of payment. Checks should be payable to Temple Emanuel. There is no tuition or fee abatement if the student is absent.

ALTERNATE PAYMENT SCHEDULE
Alternative payment schedules (i.e. monthly payments) are available - please speak with the office to arrange. Checks are to be made payable to Temple Emanuel.

PROGRAM HOURS AND ATTENDANCE
The operating hours of Kesher Newton are Monday, 2:50-5:45 PM and Wednesdays 2:50-5:45 PM, with the option of arriving at 12:30 PM for early release days. If the student is unable to attend on a scheduled day, a parent or guardian must notify Kesher Newton by written note or telephone. Drop-off and pick-up of the student at Kesher shall be in accordance with the policy set forth in the Parent/Guardian Handbook. There will be a rolling dismissal from 5:45-6:00 PM. Families who pick up after 6:00 PM will be charged $1 per minute until pick up.

ENROLLMENT PERIOD
The period for enrollment by this contract is from September 1, 2024 through the last day of the Newton public school year in June, 2025 (subject to change due to snow days).

CALENDAR
The program is closed on all national holidays, during the winter and summer vacations, February and April vacation weeks, and all other days on which the Newton Public Schools are closed. The program will also close on the following Jewish holidays: both days of Rosh Hashanah, the afternoon before Yom Kippur, Yom Kippur, the first two days and the last two days of Sukkot and Passover, the afternoon of the first Passover seder, and both days of Shavuot.

SNOW DAYS
Kesher Newton will be closed when the Newton Public Schools close due to snow emergencies. If a snow emergency occurs during the Newton Public School day, Kesher Newton will not open. If a snow emergency occurs during Kesher and Kesher has to close early, parents will be notified of the earlier pick-up time. Other Kesher Newton closing policies are set forth in the Parent/Guardian Handbook.

SNACK
Parent/Guardians will provide dairy or parve snack (and lunch for early arrival students) for their child/ren. Kesher will only provide snack on special occasions. Kesher is a NUT FREE environment. Parent/Guardian will not send their child/ren with any nut products on days that they attend Kesher and should not rely upon their child/ren to eat food with nuts at secular school before arriving at Kesher.

WITHDRAWALS
Enrollment of the student at Kesher Newton is for the full school year. In the event there are changed circumstances or another need for a parent or guardian to withdraw the student from any Kesher Newton program, Parent/Guardian must give written notice to the Kesher Director at least one month in advance of the withdrawal date. Due to staffing commitments, families must pay tuition for one month after the student leaves Kesher.

TERMINATION
Enrollment of Student may be terminated at any time if 1. in the sole judgment of the Kesher Director it has been decided that further participation in the program by the student is not in the student's best interest or in the best interest of Kesher Newton or 2. Parent/Guardian fails to comply with any of the terms of this agreement (including payment of all tuition and other fees when due). Unless more immediate action is deemed necessary or appropriate, preceding termination Parent/Guardian will have the opportunity to meet with the Kesher Director. In the event of termination, Parent/Guardian's financial obligation will not continue for the days following the Student's last day of attendance in the program. However all tuition for the time that the student was at Kesher is due within 30 days of termination. Other policies regarding termination and/or temporary suspension are set forth in the Parent/Guardian Handbook.

WAITLIST
Kesher Newton will try its best to accommodate all families who are interested. In the event that we cannot accommodate your child/ren, you will receive a full refund of all fees and tuition paid and be put on a waitlist until a spot opens.

COVID-19 ADDITION
By signing this contract Parent/Guardian agrees not to send their child to Kesher if the Student has tested positive for COVID-19. Families will follow the current CDC guildelines as to when Students with COVID-19 can return to school. If Student is asked to be home from school and/or Kesher for quarantine, there is no tuition or fee abatement. If the entire Kesher Newton program has to switch to all remote learning for a long period of time, there will be no tuition refund for Kesher, which will still be provided remotely.

ACKNOWLEDGMENT AND AGREEMENT
By the signature below Parent/Guardian agrees to enroll Student according to the provisions stated in this agreement. Parent/Guardian acknowledges and agrees that this agreement shall not be effective until it has been executed by Kesher Newton. Parent/Guardian further acknowledges and agrees that Student's enrollment at Kesher Newton is subject to, and Parent/Guardian agrees to follow, all the policies set forth in the Parent/Guardian Handbook.

I understand and agree to all of the terms and conditions outlined above.(Required)

Yes

Student 1 Kesher Deposit

Price:

Student 2 Kesher Deposit

Price:

Student 3 Kesher Deposit

Price:

Convenience Fee

Price: $0.00

Total

Payment Method(Required)

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

2024-25 Preschool Enrollment is now open!

Community

Shabbat & Prayer

Learning

Life Cycle Rituals

Music

Israel

Social Action

Temple Emanuel Education Program Enrollment Form

Religious School Pricing

Kesher Pricing

Preschool Enrollment

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Are there any changes since September 2023 to any of the following? If so, please specify the changes in space provided and upload any supporting documents (such as updated IEP)

Safety Information

Medical Information

Class Placement Policy Information

Learning Support Information

Are there any changes since September 2023 to any of the following? If so, please specify the changes in space provided and upload any supporting documents (such as updated IEP)

Safety Information

Medical Information

Class Placement Policy Information

Learning Support Information

Are there any changes since September 2023 to any of the following? If so, please specify the changes in space provided and upload any supporting documents (such as updated IEP)

Safety Information

Medical Information

Class Placement Policy Information

Learning Support Information

Family Information

Emergency Information

Transportation

Releases

Other Information

Kesher Contract

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