Official Registration for the Intensive Arabic Semester

This form is for those individuals who have already spoken to our student liaison and are ready to official enroll in the program and put down a $300 deposit. After filling out this form, you will need to pay your $300 deposit to our financial manager. For more information about the official enrollment process, please email our student Liaison.

Name *

First

Last

Email *

Phone Number *

-

Israeli Phone Number (If you have one) *

-

Address *

Line 1

Line 2

City

State

Zip Code

Country

Date of Birth *

Passport Issuing Country *

Passport Number *

Secondary passport Country (If Applicable) *

Secondary Passport Number (If Applicable) *

Are you an Israeli Citizen *

Yes No

Will you be applying/have you applied for a MASA scholarship? *

Yes No Need more information

Have you ever been to Israel before? Please explain below. *

Do you speak any other languages besides English? Are these native languages or have you studied them? Please elaborate below. *

Have you ever taken formal Hebrew or Arabic lessons/classes before? Please elaborate below. *

I will be attending *

Fall 2012 July 20, 2012 to December 20, 2013) Spring 2013 (January 20, 2013 - June 20, 2013)

How did you hear about the program? Please be specific. If a friend told you about it, please tell us his/her name. If you found it on another website, please tell us which website. *

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