The Magbit Foundation of Greater Los Angeles

The Magbit Foundation Of Greater Los Angeles The Iranian Sponsored Student Loan Program Application For Academic Year 20___/ 20___ Haifa University By submitting this loan application, the applicant acknowledges that the loan application and any portion there of, the applicant’s name and background information, the applicant’s picture submitted herewith, and all other materials submitted herewith or hereafter by applicant to Magbit Foundation may be used, copied, reprinted, and/or distributed by Magbit Foundation at any time, without the knowledge or consent of the applicant, for purposes relating to the Magbit Foundation, including, without limitation, to raise funds for the organization. The applicant hereby consents to the foregoing.

Please complete this application answering all questions and return along with: A- 1 passport photograph of yourself: B- A letter (in English) stating brief history of your family, academic background and any special honors or academic achievements. NOTICE: Applications that are not completed will automatically be rejected.

Date …………………………………..Teudat Z’hut Number………………………. Use Name under which you are registered at the University:

First Name ……………………………….Last Name ……………..…...

Phone # …………...... Email ......

Home Address………………………………………………………………………………..

Date of Birth ……………..…Date Of Aliya………………..Country of Birth …………………………….

Single……Married…….Divorced……Widow(er)…..Number of Children…….. Number of siblings…….

Military or National Services: Yes______No______Academic reserve: Yes ______No_____

Father’s Name ………………………Occupation……………….Country of Birth ……………….

Mother’s Name …………………….Occupation………………..Country of Birth ……………….

Field of Study……………………………Title of Drgree…………..Expected Year of Graduation………

Number of years studied towards this degree(not including high school and the current year)…….. Number of years to complete studies towards this degree (including the current year)……….. Have you received Magbit loans before, ……….if yes, how many years………total to date………… Amount of loan requested this year in U.S. Dollars…………………. 1. I hereby declare that all the information provided above is full and accurate. 2. I am aware and agree that the University has every right to check the details whenever needed. 3. If granted, I promise to repay the loan back to the University/College under the conditions specified so that funds may be used in the future by other students attending the University.

SIGNATURE OF THE STUDENTS ……………………………….

For use by Magbit only:

Not Approved………………………Approved………………………….Amount$……………………….. Comment: