Technion International School
Dear Applicant,
Thank you for showing an interest in the Technion – Israel Institute of Technology. To maximize your
chances of acceptance into our program, please review the following important information regarding the
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 is
submitted. 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 requesting to waive 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 - 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. Sawsan Brik
Tel: +972-77-887-1897, Fax: +972-77-887-1852
Email: admissions@int.technion.ac.il
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 candidate. The 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 admissions@int.technion.ac.il 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.
CV
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:
Zip Code:
City:
State:
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:
Father’s Profession:
Name of Mother/Legal Guardian:
State:
Country:
Please add a
picture
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
website
Israeli Foreign
Ministry
From a former
participant
Technion
Society
High school
The Jewish Agency
Google, Facebook, Representative visit,
Other:
Educational History
Education/university degrees:
I have completed a high school degree and have not yet started higher education.
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 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.
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 admissions@int.technion.ac.il or by mail to our mailing
address.
School 1:
Name of School:
Address:
City:
Zip Code:
State:
Country:
Telephone Number of School: Country Code:
Area Code:
Date of commencement of studies (DD/MM/YYYY):
Date of completion of studies (DD/MM/YYYY):
Public School
Private School
/
/
Number:
/
/
Religious School
Language of Instruction:
School 2:
Name of School:
Address:
City:
Zip Code:
State:
Country:
Telephone Number of School: Country Code:
Area Code:
Date of commencement of studies (DD/MM/YYYY):
Date of completion of studies (DD/MM/YYYY):
Public School
Private School
Language of Instruction:
/
/
/
Religious School
/
Number:
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, 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: 5839
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:
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.
Form C – Financial Assistance
Request for Financial Assistance Form: Scholarship Application:
Please fill out this form together with:
1.
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.
2.
Your and your parents tax forms, original form and English translation for 2012 or 2013 as applicable.
3.
For salaried employees - you and your parents’ or guardians’ three most recent pay check stubs.
4.
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:
Gender:
Status in Israel:
First Name:
Tourist
Middle Name(s):
New Immigrant
Amount Requested (for a single year): $
Returning Minor
(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:
Student
Spouse, 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:
Current Market Value: $
Year purchased
Purchase Price:
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?
Yes
No
Does either parents own all or part of a business, corporation or partnership?
If yes, provide the following information: Name and Line of business:
Parents’ Assets:
Cash, checking and savings
Total Investments, Savings, etc.
Parents Home
Own
$
$
Yes
No
Full Address:
Real Estate
$
Any Other Assets $
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):
/
/