We Strongly Recommend You Send in All Forms As Early As Possible

Technion International School

Dear Applicant,

Thank you for showing an interest in the Technion – Israel Institute of Technology. To maximize your chancesof acceptance into our program, please review the following important information regardingthe application process. All forms submitted must be typed or neatly handwritten in ink. The completed application must be sent to the Technion International School.

We strongly recommend you send in all forms as early as possible.

Application Fee

The regular application fee is $50 U.S. (Or its equivalent in Euros).

The fee must be submitted with the application. The application will not be evaluated unless the fee issubmitted. Please make checks payable to Technion- Israel Institute of Technology. (Appendix attached)

In special cases the applicant may ask for a waiver of the application fee. The form requestingtowaive this fee is included in the documents below.

Application Form Package

Form A -General, Biographical Information, Educational History, Student Payment

Form B - Student Health Declaration

Form C –Student Payment

Form D - Financial assistance (optional) - only if requesting financial aid and/or to waive the application fee

All documents should be submitted in English, All translations should be certified.

Please send your application documents to the following address:

Technion International School

Technion - Israel Institute of Technology

Mauerberger Building, 2nd floor

Technion City, Haifa 320000, ISRAEL

ATTN: Ms. Chava Magder- Cohen

Tel: +972-77-887-1897, Fax: +972-77-887-1852

Email:

General Instructions

Recommendation letters

Please submit 2 recommendation letters, at least one from your math or science teacher. An original copy has to be sent directly by the evaluator. (See option of recommendation letter attached)

For Evaluator:

Please describe the candidate and address the following items: academic strengths and weaknesses, motivation, abilities in mathematics, physics and English, place (ranking) in class, ability to adapt to a new environment, social strengths and weaknesses, social skills and any other subjects you deem important for us to know about the candidateThe recommendation letter should be at least one page length.

Please describe only those traits about which you have gathered strong indications of the candidate.

You can send the complete form via e-mail to or enclose it in an envelope and sign your name over the flap of the sealed envelope. Please give the envelope to the applicant.

Essay

Please write a brief personal essay (no more than two typed pages) that will provide more insight about you and demonstrate your ability to organize your thoughts and express yourself. You may write about a topic of your choice or select one of the topics below; indicate clearly which topic you select. Please submit your typed response on separate sheets of paper and include your name and signature on each attached sheet.

A.Evaluate a significant experience, achievement, risk or ethical dilemma you have faced and its impact on you.

B.Discuss a personal, local, national or international concern and its importance to you.

C.Discuss a person who has had a significant influence on you and describe that influence.

D.Describe a character in a novel or other creative work that you most relate to and why.

E.Explain how Israel has affected you and why studying and living in Israel is something that is of interest to you.

F.Describe developments in your life that have sparked an interest in learning at the Technion.

G.Topic of your choice.

Please include your résumé (CV) outlining your employment history, scholastic distinctions, volunteer work and community service. Please make sure to include your signature and date.

Form A - General

Biographical Information

Applicant’s Name:

Surname: First Name: Middle Name(s):

Gender:

Date of Birth: (DD/MM/YYYY) //

Place of Birth:City: State: Country:

Country of Citizenship:

Passport No: / I.D. No. Type of Identification:

Additional Citizenship:

Contact Information

Home Address:

City: State:

Zip Code:Country:

If you would like mail to be sent to a different address please outline below:

Number and Street: City: State:

Zip Code:Country:
E-Mail:

Telephone Number: Country Code: Area Code: Number:

Applying for:

Undergraduate Program – BSc in Civil and Environmental Engineering

Freshman Year of Engineering and Science

Family Information:

Name of Father/Legal Guardian:

Father’s Current Citizenship:

Father’s Place of Birth: City: State: Country:

Father’s Profession:

Name of Mother/Legal Guardian:

Mother’s Current Citizenship:

Mother’s Place of Birth: City: State: Country:

Mother’s Profession:

Parents’ Address (if different from yours):

City: State:

Zip Code:Country:

Names and ages of siblings:

How did you learn about our program?

Technion web site / From a former participant / High school / The Jewish Agency
Israeli Foreign Ministry / Technion Society / Google, Facebook, Representative visit, Other:

Educational History

Education/university degrees:

I have completed my BSc/B.A. studies (give details, list dates of graduation/completion and names of granting institute/s). Please attach your original transcript or a certified copy of it.

I am currently studying for my BSc/B.A. at the following institution (give details). Please attach your original transcript or a certified copy of it.

I have completed a high school degree and have not yet started higher education.

Secondary Schools:

List the secondary schools you have attended. List the most recent school attended first. An original copy of all you high school transcripts must be sent directly from the High School either via email to or by mail to our mailing address.

School 1:

Name of School:

Address:

City: State:

Zip Code:Country:

Telephone Number of School: Country Code: Area Code: Number:

Date of commencement of studies (DD/MM/YYYY): / /

Date of completion of studies (DD/MM/YYYY):/ /

Public School Private School Religious School

Language of Instruction:

School 2:

Name of School:

Address:

City: State:

Zip Code:Country:

Telephone Number of School: Country Code: Area Code: Number:

Date of commencement of studies (DD/MM/YYYY): / /

Date of completion of studies (DD/MM/YYYY):/ /

Public School Private School Religious School

Language of Instruction:
English Proficiency:

Graduates of high schools in which English is not the primary language of instruction must demonstrate English-language proficiency by providing results of TOEFL (Test of English as a Foreign Language, US) or IELTS (International English Language Testing System, UK) exams) or an equivalent test, such as the IELTS (International English Language Testing System), the SAT Reasoning, or ACT Plus Writing Test.

TOEFL/IELTS Score:

Please also submit an official score report issued by the testing agency.

Technion TOEFL code is: 5776

Standardized Tests:

Please tick the box below if you have taken one of the following tests:

SAT

Israeli Psychometric Entrance Exam

ACT

Standardized Test score:

Math/Cumulative section score:

Please also submit an official score report issued by the testing agency.

Technion SAT code is: 5899

Technion ACT code is: 5339

Signature and Personal Consent

I certify that I have answered the above questions truthfully and completely to the best of my knowledge. I agree to report any relevant changes in the information given above. I acknowledge that any omission or inaccurate information could jeopardize my application for admission to the Technion. I agree that this application and accompanying documents shall be stored in the Technion student record data bank.

Signature: ______Date: (DD/MM/YYYY):/ /

Form B – Student Health Declaration

I the undersigned:

Full Name: S.S. No. (If applicable):

Passport No.:Citizenship:

Permanent Address:

My health condition is normal and I do not have any illness

I have the following illness. (Please specify)

I am currently not receiving medical care

I am currently receiving medical care. (Please specify)

I am not and never was addicted to drugs or alcohol

I was addicted to drugs or alcohol

I was never hospitalized

I was hospitalized*

In (Hospital):

For the following reason(s):

I do not have learning disabilities

I have learning disabilities that require me to receive special study conditions and considerations during the course of study and/ or during exams*

I have the following learning disabilities:

I hereby declare and confirm the above information is accurate

Day: Month: Year: Signature: ______

*If you were hospitalized more than once, please attach a document to this form indicating full details regarding your hospitalization.

** I am aware that if found eligible to be accepted into the program I will be asked to sign a “Permission to Access personal Medical Records” form.

Form C – Student Payment Form

First Name: Last Name:

Country: Passport Number: Date:

Amount: Name of Program:

Please choose a method of payment and check the appropriate box.

After completion, please send this form to:

USD by Bank transfer:

Beneficiary: Technion Israel Institute of Technology-International School

Account number: 7002/44

Bank: Bank Leumi Le Israel B,M ,Bank no. 10

Account (IBAN): IL930108780000000700244

Branch: Hadar – Haifa , Branch number: 878

Address: 33 Herzel St., Haifa 33504 Tel: +972-4-8612888

Bank Swift Code: LUMIILITTLV

NIS by Bank transfer:

Beneficiary: Technion Israel Institute of Technology-International School

Account number: 15300031

Bank: Bank Leumi Le Israel B,M ,Bank no. 10

Branch: Hadar – Haifa , Branch number: 878

Address: 33 Herzel St., Haifa 33504 Tel: +972-4-8612888

Please scan and email a copy of your transfer certification to: or Fax to +972-77-887-1852.

Personal check

Made out to the Technion Israel Institute of Technology

Please send to:

Mauerberger Building, 2nd floor

Technion International

Technion City, Haifa

32000, Israel

ATTN: Ms. Liubov Baladzhaeva

Credit Card:

Type of Card:

Card number:

Card holder:

Expiry date:

Form D – Financial Assistance

Request for Financial Assistance Form: Scholarship Application:

Please fill out this form together with:

A typed one-page letter that explains the financial background of the applicant/student and his or her parents, and the reason(s) for requesting a scholarship.
You and your parents tax forms, original form and English translation for 2012 or 2013 as applicable.
For salaried employees - you and your parents’ or guardians’ three most recent pay check stubs.
We may request additional information and/or documents required to verify and approve your request for financial aid.

Please note that approval of financial aid for additional years is dependent on academic achievements and financial need.

Applicant/Student Name:

Surname: First Name: Middle Name(s):

Gender:

Status in Israel:TouristNew ImmigrantReturning Minor

Amount Requested (for a single year): $ (All amounts should be denominated in $US)

Will you receive or are you applying for any financial assistance of any kind, from any Israeli or non-Israeli organization, government? If yes, please indicate the sum you received.
$ Source:

Did you receive a scholarship from any other source during the last academic year? If yes, please indicate the sum you received.

$ Source:

Student (and Spouse) Gross 2012-13 Income:

StudentSpouse, if married

Income from work $$

Public Assistance$$

Social Security$$

Other income$$

Student (and Spouse) Assets:

Cash and Savings: $ Investments: $

Uniform gifts to minors:$ Other assets: $

If you own a home: Year purchasedPurchase Price:$

Current Market Value: $ Unpaid Mortgage Principle: $

Family Information:

Name of Father/Legal Guardian: Age

Father’s Profession: Employer

Name of Mother/Legal Guardian: Age

Mother’s Profession: Employer:

Parents’ Gross Income:

2013 Estimated 2014

Wages, salaries, bonuses $$

Interest income$$

Dividend income$$

Net income or loss from

business, rents, royalties, $$

partnerships, estates, trusts, etc.

Untaxed income$$

Is either parent self-employed?YesNo

Does either parents own all or part of a business, corporation or partnership? YesNo

If yes, provide the following information: Name and Line of business: Full Address:

Parents’ Assets:

Cash, checking and savings$ Real Estate $

Total Investments, Savings,etc.$Any Other Assets$

Parents Home Own Rent – monthly payments $

If your parents own their home:

Year purchased:Purchase Price: $ Current Market Value$ Unpaid Mortgage Principle: $

Indicate the amount your parents feel they can contribute toward your coming year expenses: Amount $

I certify that all the information presented on this application is correct at this time.

I will provide timely notice of any significant change in family income or assets, family situation, or the receipt of tother scholarships or grants.

Full Name: Signature: ______Date (DD/MM/YYYY): //