SPRING 2006 APPLICATION FOR NEW STUDENTS

TODAY'S DATE

FIRST NAME

MIDDLE NAME

FAMILY NAME

F-1 J-1 H-1

VISA TYPE

DATE OF BIRTH (MM/DD/YYYY)

STUDENT NUMBER

US PHONE NUMBER

E-MAIL

FLORIDA ADDRESS

FLORIDA CITY

ZIP CODE

COLLEGE YOU WILL ATTEND

MAJOR

ASSOCIATES BACHELOR MASTERS DOCTORATE

DEGREE YOU ARE SEEKING

ISRAELI CONTACT NAME

ISRAELI CONTACT ADDRESS

ISRAELI CONTACT CITY & ZIP CODE

ISRAELI CONTACT PHONE

ISRAELI CONTACT E-MAIL

MAY WE INCLUDE YOUR NAME, ADDRESS AND PHONE NUMBER ON A MAILING LIST THAT WE DISTRIBUTE TO OTHER ISRAELI STUDENTS IN FLORIDA? YOUR ANSWER WILL NOT AFFECT YOUR SCHOLARSHIP

YES NO

NUMBER OF CREDITS YOU ARE ASKING FOR

GRADUATE

SEMESTER

UNDERGRADUATE

Spring 2006

CLASS STANDING

FRESHMAN SOPHOMORE JUNIOR SENIOR GRADUATE DOCTORAL DO NOT KNOW

ESSAY QUESTIONS (PLEASE FILL IN THE BOXES BELOW)

1. The purpose of the Florida-Israel linkage institute is to promote social, cultural, academic, scientific and business linkages between Florida and Israel. How do you imagine you will be able to use your field of specialization to strengthen ties between Florida and Israel?

2. When do you plan to complete your program of study?

3. What do you plan to do after you graduate?

4. How do you think you could help promote the Florida-Israel connection while you are a student?

IF YOU ARE A NEW STUDENT, ALONG WITH SUBMISSION OF THIS APPLICATION YOU MUST SEND: 1. A COPY OF YOUR US VISA 2. COPY OF YOUR HIGH SCHOOL DIPLOMA OR BAGRUT (IN ENGLISH AND HEBREW) 3. AN OFFICIAL TRANSCRIPT (ONLY IF YOU ARE ALREADY A COLLEGE STUDENT OR HAVE GRADUATED FROM A COLLEGE) 4. LETTER OF ACCEPTANCE FROM A PUBLIC FLORIDA COLLEGE OR UNIVERSITY

************************************************************************************************************************ BY SUBMITTING THE APPLICATION, I UNDERSTAND THAT I MUST RETURN TO ISRAEL WITHIN THREE YEARS OF COMPLETING MY STUDIES FOR AT LEAST AS LONG AS I HELD A FLORIDA-ISRAEL INSTITUTE OUT-OF-STATE TUITION EXEMPTION SCHOLARSHIP ***********************************************************************************************************************

After clicking the SUBMIT botton you should get a screen with your application. It usually means that the process went OK and we should get your application electronically. However,we strongly recommend that you contact us after submitting the application to make sure we actually got it.