Application to set a one on one meeting at the Accessibility & Study Skills Center Please read the following form and fill out as specified: Target audience: Students who are acknowledged by the Dean of Students Affairs as students with Learning Issues and or Attention Deficit Disorders, students with physical, sensory or cognitive disabilities, as well as students with a temporary/permanent medical condition which has implications on the student's learning abilities. Length of meeting – 50 minutes What will be taught? A one on one meeting for acquiring academic learning skills: tools and techniques for efficient studying, and for dealing with difficulties that accompany the student with learning issues. The emphasis is on practice and implementation making this an individually adapted process. Learning process and number of meetings: The number of meetings in the center is set individually and depends on the work process and cooperation of the teacher and the student. When the teachers at the center are overbooked, priority will be given to, first year students or students who have not yet had meetings at the center. The number of meetings required is a professional decision and will be decided by the professional staff of the Center. Fee: The service is provided for a nominal fee. Student: 50 NIS per personal meeting. Student receiving a socio-economic scholarship: 20 NIS per me eting. The total payments collected for this service go back, into expanding and improving the Accessibility & Study Skills Center! Payment process: students must pay before each meeting and save the receipt! 1. Via credit card through the Center’s website www.idc.ac.il/eng/ssc 2. Cash/ Credit card at the financial department next to the tuition fee department – through Ms. Alice Mazkeret/ Ms. Sigal Israeli. Debts for Center services – procedure A student who owes the Center money for any of its services cannot enjoy any other service of the Center until the debt is settled. IDC Herzliya -The Lea & Naftali Ben-Yehuda Accessibility and Study Skills Center P.o.b 167 Hetzliya, 46150 │ www.idc.ac.il/ssc │ Tel: 09-9602738 │ negishut@idc.ac.il If a student does not settle his or her debt, the debt will be added to his owed tuition fees, according to the Dean of Students Affairs decision. Commitment: registration for a one on one meeting constitutes a commitment to attend the meeting. The hours dedicated to the Accessibility & Study Skills Center are few and as such each hour matters! Canceling a meeting: If a student cannot attend the one on one meeting already set, the student must notify in writing via email to negishut@idc.ac.il and the teacher (with whom the meeting was set), no later than 48 hours prior to the meeting. If the cancellation notification is not received in time, the student will be charged for the meeting. Note: A student that misses more than one meeting without notification will not be able to continue using the services of the Center until there is a clarification with the head of the Center. Location: the Center is located in the Faculty Offices 12, in the tzimers between Ivcher Auditorium and the Career Center. Number 4 on the IDC campus map Additional information on the activities and the services the Center provides is on our website www.idc.ac.il/sscאנגלית Contact us Daphne Ingram – Administrative coordinator, the Lea and Naftali Ben-Yehuda Accessibility & Study Skills Center Phone: 09-9602738, email: daphne.ingram@idc.ac.il negishut@idc.ac.il The office is located next to the the career center – building 3 on the campus map For the one on one meeting application form see the following page Please fill it out and send it to Ms. Daphne Ingram: daphne.ingram@idc.ac.il IDC Herzliya -The Lea & Naftali Ben-Yehuda Accessibility and Study Skills Center P.o.b 167 Hetzliya, 46150 │ www.idc.ac.il/ssc │ Tel: 09-9602738 │ negishut@idc.ac.il Application for a one on one meeting at the Accessibility & Study Skills Center 1. I am acknowledged by the Dean of Students Affairs, as a student with Learning Issues and or Attention Deficit Disorders, students with physical, sensory or cognitive disabilities, as well as students with a temporary/permanent medical condition which has implications on the student's learning abilities. 2. I agree that, if necessary, the staff of the Accessibility and Study Skills Center will read my medical diagnosis that I submitted to the Dean of Students Affairs. 3. I am aware that each meeting is 50 minutes long. 4. I am aware that I must pay in advance for each one on one meeting and save the receipt. Payment: Via credit card through the Center’s website www.idc.ac.il/eng/ssc Via cash/ credit card at the financial department next to the tuition fee department – through Ms. Alice Mazkeret/ Ms. Sigal Israeli. 5. My preferred date & time for weekly one on one meeting: (please state all the options which are possible for your one on one weekly meetings): Days: Sunday, Monday, Tuesday, Wednesday, Thursday _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 6. I am entitled to a scholarship (based on socio-economic background) as a student at IDC during this school year (specify which scholarship): _____________________________________________________________________ _____________________________________________________________________ 7. I am aware that by sending this email I am committed to attend the time set for me. 8. Cancellation: I am aware that if I cannot make a one on one meeting already set for me, I must notify in writing via email to negishut@idc.ac.il and the teacher (with whom the meeting was set), no later than 48 hours prior to the meeting. If the cancellation notification is not received in time, I will be required to pay for the meeting. Note: A student that misses more than one meeting without notification will not be able to continue using the services of the Center until there is a clarification with the head of the Center. Debts for Center services – procedure IDC Herzliya -The Lea & Naftali Ben-Yehuda Accessibility and Study Skills Center P.o.b 167 Hetzliya, 46150 │ www.idc.ac.il/ssc │ Tel: 09-9602738 │ negishut@idc.ac.il A student who owes the Center money for any of its services cannot enjoy any other service of the Center until the debt is settled. If a student does not settle his or her debt, the debt will be added to his owed tuition fees, according to the Dean of Students Affairs decision.. I have read and I hereby agree to all that is written in this form: Full name: _______________________________________ ID number : _______________________________ School: __________________________________________ Year of study: _________________________________________________ Mobile phone number: _________________________________________ Email: _______________________________________________________ Please fill out and send to Daphne Ingram: daphne.ingram@idc.ac.il IDC Herzliya -The Lea & Naftali Ben-Yehuda Accessibility and Study Skills Center P.o.b 167 Hetzliya, 46150 │ www.idc.ac.il/ssc │ Tel: 09-9602738 │ negishut@idc.ac.il