Columbia University in the City of New York
Application for Exchnage 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 Name and Address:
Department: Degree: Years Completed: Average/GPA:_____ (Please note that we request a minimum of 80/100).
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 Handwrite
Applications must identify the desired department to visit at the Technion, and include:
1. Official Grade transcript - please send copy via email and original via air-mail (will not be returned)
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. Exchange students (from partner universities) are exempt from tuition fee.
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. Student Fees: including student union fee, security and welfare for the sum of 550 NIS per semester.
2. 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.
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 12 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: ___________________
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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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