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Application for Visiting Students at the Technion

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Applicant Information: Program:

Family Name:       First Name:      

Date of Birth:      E-mail:       Tel:      

Home Address:       City:       State/Province:       Country:      

Nationality:       Passport Number:       Sex:

Current Affiliation

Home University and Address:      

Department:       Degree: Years Completed:

Details of Requested Visit

Requested Faculty (Department) to Visit at Technion:      

Requested Dates for Visit: Year:       Semester:

Specific Dates:       to       Knowledge of Hebrew:

Already contacted a host at the Technion?      

Do you want dorms at the Technion?      

Do you have any medical/ physical conditions that might influence your visit?

Date:       Student's Signature:________________________________________

Approval of Home University – must be signed

Name:       Position:      

Signature: _______________________ Stamp: _______________________ Date:      

Complete and send this form along with the appropriate fee after reading the information below.

______________________________________________________________________________________________________________________

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Information for Students Visiting the Technion

1. Application: Form must be completed and submitted by e-mail to incoming@int.technion.ac.il.

Do NOT Hand-write

Applications must identify the desired department to visit at the Technion, and include:

1. Original Grade transcript - please send via air-mail (will not be returned to student),

2. Current CV/Resume,

3. Cover letter outlining academic interests,

4. Letters of recommendation from two home faculty members.

5. Course Request form (N/A for Research students)

2. academic Fees: Must be paid prior to arrival to the Technion International School, according to student payment form below.

1. Processing fee of $250 per semester.

2. Tuition Fee:

1. Visiting students: Tuition is $7000 per semester or $14,000 per year (processing fee is included).

2. Research students are exempt from the tuition fee. If you wish to take courses you will need to pay

1500 NIS per credit point.

3. Campus Fees: Must be paid upon arrival in NIS to the Technion Student Account department.

1. Accommodation Fees:

1. Dorms cannot be guaranteed for visiting students. If dorms are available, rent fee for dorms for

International visitors start at 916 NIS per month.

2. Monthly charges such as Electricity, water and internet are not included and will be added to the

monthly rent.

2. Student Fees: including student union fee, security and welfare for the sum of 550 NIS per semester.

4. Health and Accident Insurance must be arranged prior to arrival at the Technion either through an agent in the home country/state or a local agent working with the Technion (Amos Gilboa, Phone: 972-3-6386216; Fax: 972-3-6874534; e-mail: mali@yedidim.co.il).

5. Academic Advisor: The International School will assign an academic advisor to applicants who will approve the academic program.

6. Please note:

1. Incomplete application package will not be processed.

2. Application process may take up to 10 weeks and you should plan your arrival accordingly.

Technion International School - Mauerberger Building, Room 331

Technion – Israel Institute of Technology, Haifa 32000, Israel

Email: incoming@int.technion.ac.il Telephone: +972-4-8292964, Fax: +972-4-8293773

Course Requests

Please fill out the courses you are interested in taking. You can find the list of courses in this website:

(Course lists are not final and courses may be added on demand or cancelled if an insufficient number of students register)

Name of student:_____________________ Date: ______________________

Name of Home University: ___________________

| |Course Name |Course Number |Faculty/ Department |Do you have the pre-requisites for the |

| | | | |course? |

|1 | | | | |

|2 | | | | |

|3 | | | | |

|4 | | | | |

|5 | | | | |

|6 | | | | |

|7 | | | | |

|8 | | | | |

|9 | | | | |

|10 | | | | |

Technion Student Number: ______________

Form F – Student Health Declaration

I the undersigned:

Full Name:       Passport No.:      Citizenship:     

Permanent Address:      

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

I have the following illness. (Please specify)      

2. I am currently not receiving medical care

I am currently receiving medical care. (Please specify)      

3. I am not and never was addicted to drugs or alcohol

I was addicted to drugs or alcohol      

4. I was never hospitalized

I was hospitalized*

In (Hospital):      

For the following reason(s):      

5. 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:      

6. 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.

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

After completion, please send this form to: incoming@int.technion.ac.il

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: incoming@int.technion.ac.il

USD / NIS by Bank transfer:

Beneficiary: Technion Israel Institute of Technology-International School

Account number: 373800/89

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

Account (IBAN): IL530108760000037380089

Routing Number: IL010876

Branch: Haifa , Main Branch number: 876

Address: 21 Jaffa St., Haifa 33504 Tel: +972-076-8687655

Bank Swift Code: LUMIILITXXX

Please note THE BANK DEDUCTS a small percentage, which you must take into consideration and account. If the final amount which the bank here transfers to the Technion's account is less than what you have to pay, you will have to see to it that the difference is covered.

Please scan and email a copy of your transfer certification to: incoming@int.technion.ac.il

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: Orna Nagar-Hillman.

Credit Card:

Type of Card:      

Card number:      

Card holder:      

Expiry date:      /     /     

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