Ben-Gurion University Of The Negev Application Form

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Personal Information

First Name

Middle Name

Last Name (Surname)

Gender

Email:

Date of Birth

Phone Number

Passport Number

Please enter your passport number and not your ID number. For US students: If you don't currently possess a passport, please insert the last 4 digits of your SSN

Country of Citizenship

Permanent Address:

Please include full address, City, Country and Zip Code

Education

Home University /College/ School

In case you are not currently enrolled, please fill out NA in order to proceed.

University Location

Level Of Study

Major

Education History

Please list all secondary schools and colleges/universities you have attended in chronological order, from newest (most current) to oldest:

Institution 1

Institution 2

Institution 3

Institution 4

Do you currently attend a university associated with the University of California school system?

YesNo

Have you ever transfered or withdrawn from any school for any reason?

YesNo

Please explain

Have you ever been dismissed, suspended, or denied readmission to any school?

YesNo

Please explain

Have you ever been placed on probation (academic, disciplinary, etc.) by a school?

YesNo

Please explain

Academic and Extracurricular Activities

List academic honors, awards or scholarships recieved

List your principle extracurricular activities inluding leadership positions held

List your community activities (student groups, religious and civic organization, etc.)

Program of Interest

Program

Please note: Select only one program. If you are applying for the OSP program, you are required to take the pre-semester Ulpan as well.

Academic Year

2018-2019

Academic Year

Semester of Study

Short Term

Requested internship Start Date

Requested Internship End Date

Override

yes

Internship field of interest

How did you hear about us?

Please specify

Accomodation

*Guest Apartments upon availability and for additional cost

Advisor

Do you have an advisor at BGU?

YesNo

Advisor's Name

Advisor's Email

Home Institution Study Abroad Contact Information

Study Abroad Contact Name

Study Abroad Contact Job Title

Study Abroad Contact Email

Study Abroad Contact Office Phone

Recommendations

An Email will be sent to the recommender on your behalf asking to upload the recommendation letter.

(Family members can not be considered as personal recommenders)

	Salutation	Full Name	Email
Academic
Personal

Required Documents

It is possible to upload an unofficial copy for your transcript and send the official copy to the New York office at: AABGU 1001 6th ave New York, NY 10018 ATT: Jonathan Hakim

Official copy of your Transcript of Study

1 Academic Recommendation Letter

Personal Statement/Motivation Letter

Resume/CV

A scanned copy of your Passport

A digital photograph (JPG)

Have you been nominated as an exchange student by your University?

YesNoIf selected "Yes", please make sure you chose "Exchange Program" in the Program of Your Choice field above.

Exchange information

Home Institution Name

Home Faculty

Home Department

Student Exchange Representative

Which department(s) are you interested in studying at BGU?

Email of Exchange Representative:

I am interested in the following:

Pre-Semester Hebrew Language UlpanOn-Campus HousingHealth Insurance

Application

True

Are you interested in on-campus housing? (more information here)

YesNo

Assess Your Hebrew Level

Program type

OSP

Program Type

Exchange

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