APPLICATION FORM FOR INTENSIVE ARABIC SEMESTER

This form is for those individuals who have already spoken to one of our enrollment specialists and are ready to enroll in the program and pay the $250 application processing fee. After you have completed this form and paid the fee, you will be invited to an online interview with the Director of Arabic Studies for International Students at Givat Haviva. The $250 is refundable only in the event you are unable to obtain a suitable entry visa to Israel.

Applicant Information

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Emergency Contact

For Study Abroad Students

Do you need Givat Haviva to contact the study abroad office directly? *

References

Reference from Study Abroad Office / Academic Advisor / Employer / Other

Language Proficiency

If you know your CREF/ ACTFL/ ILR ranking please insert these. If not, please rank yourself on a scale of 1-5 with 5 being full fluency.
 *
 SpeakingReadingWriting
English
Hebrew
Arabic
Other
Please indicate which of the following categories you have knowledge of in SPOKEN Arabic. *

Housing and extra services

Which, if any, of the below additional services, would you like us to assist you with? (services charged separately) *
 

Medical Data

If yes, please indicate the condition and the implications for your studies and/or daily living, and provide a letter from your treating physician indicating details of your condition and treatment and implications for your study abroad experience in Israel. Your application will be considered regardless of any disability, but it will affect the medical insurance provided.
 
You'll need to have your physician complete and sign the Report of Medical Examination form. Please email us to receive this form. The completed form will need to be sent via postal mail to: Lirom Study in Israel, Wiesmann 87, Kfar Saba 44363401. We will keep your medical forms private and only share it with Givat Haviva's International Students department and the health insurance provider.

STATEMENT OF PURPOSE

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Application Fee

To complete your application and pay the application fee of US $250, please choose one of these options:
DIRECT BANK TRANSFER: Paypal to http://paypal.me/studyinisrael
Bank name: Bank of America  Make sure to add $9 Transaction fees.
Owner: Study in Israel LLC  
Account number: 385017363882  
Connecticut, New Haven  
Swift code: BOFAUS3N
Wire transfer routing number: 026009593
 
Please send a screenshot or scan of the payment confirmation in JPEG, GIF, PNG, BMP. 

Declaration

 
By signing and submitting this form, I certify that all the information submitted is complete and correct, and I agree to abide by all the regulations of the Givat Haviva.
 
By signing, I confirm that I am aware that it is my responsibility to obtain a suitable visa: Volunteering, MASA or Israeli passport, and I am aware of the new law in Israel which denies entry visas to Israel to anti-Israel activists and BDS-supporters. 
Signature *
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