<p> PZC Hagshama Shalom Applicant,</p><p>Thank you for your interest in our program. Please find below all information regarding the requirements to successfully complete your registration process for the Kibbutz Ulpan program. We recommend you use it as a checklist. 1. Fill out FORM 1 (must be typed!): Kibbutz Ulpan Application, and send it back to us (email) 2. Print & carefully read FORM 2: Participation Agreement, and send it back to us signed (email). 3. Print & carefully read FORM 3: Applicant Declaration, and send it back to us signed (email). 4. Print out, fill out (you and your doctor) the two attached Medical Forms (in PDF format), and send them back to us signed by you and your physician (email). Please note: failure to disclose all known and relevant medical information prior to arrival might result in expulsion from the program without refund! 5. 4 original passport photos - BRING THESE WITH YOU WHEN YOU ARRIVE IN ISRAEL 6. MASA ISRAEL: PZC Hagshama organizes the Kibbutz Ulpan Program in cooperation with MASA, a project operated by the Government of Israel and the Jewish Agency for Israel. MASA sponsors our program, and financial support is available for eligible applicants, based on country of origin, program length, and personal or family financial situation. When you register for the program, simultaneously check your eligibility for a MASA flight ticket, grant or scholarship. Visit their website: http://www.masaisrael.org/Masa/English/MASA+Grants/ , and click the "APPLY NOW" button. Processing of the application takes approximately 45-60 days. Applicants are then informed directly by Masa of the amount allocated to them. All scholarship forms must be submitted before the start date of the ulpan. We will contact you by email upon receiving your application. 7. You will be invited for a face-to-face or Skype interview by our representative. 8. Arrange payment for the program (read further details below) 9. Upon approval for the program and after payment and you will receive an Acceptance letter from us (Kibbutz Program Center). 10. VISAS (Note that bearers of Israeli passports do NOT need any visa, just a letter of deferral.) If you are awarded financial aid from MASA, you need to go to the Israeli Consulate/Embassy to get an A2 (MASA) visa to Israel (free of charge). Needed documents: 1) passport which is valid for at least ONE YEAR from the date you plan to enter Israel, 2) our acceptance letter, and 3) the letter of participation that you will receive from MASA. IMPORTANT: WE RECOMMEND ARRANGING YOUR A2 MASA VISA BEFORE ARRIVAL IN ISRAEL: If you are not eligible for MASA aid, please contact our "Kibbutz Ulpan" Program office by phone or mail, in order to receive information how to obtain a B2 (tourist) visa for the duration of the program. PAYMENT All payments must be made directly to PZC Hagshama in Israel. To ensure a place in the program, all due payments have to be in our possession one month prior to the beginning of the program. Make payments available to: Bank Name: Bank Hapoalim Bank number: 12 Branch number: 524 Address of Bank: Ramat Efal, Israel Account name (beneficiary): P.Z.C. Hagshama Account number: 170479 IBAN: IL82-0125-2400-0000-0170-479 Swift Code: POALILIT Kibbutz Program Center, 25 Broadway 9th floor New York NY 10004 Telephone: 212.462.2764. [email protected] http://kibbutzprogramcenter.net</p><p>PZC Hagshama In some cases, you'll be asked for our address and name, which is: PZC Hagshama, 1 Hayasmin St., Ramat-Efal 5296000, Israel</p><p>Please note:  The ordering customer (you) pays for the transfer/bank charges (OUR) – Incomplete payment may cause delay in the registration process.  Name of the PARTICIPANT & THE PROGRAM must be mentioned in the description of the transfer, (e.g.: JOSHUA LEVY MAAGAN MICHAEL).  You must email ([email protected]) us proof of payment (the confirmation document you receive from your bank) so that we can track it.</p><p>If you have any questions, please contact Emma on 212.462.2764</p><p>Please note: How much should you pay? The total cost of the classic Kibbutz Ulpan Program (including the registration fee) is US$ 6,010. The price includes: accommodation, meals, Hebrew lessons, trips around Israel and medical insurance for the duration of the program.</p><p>If you receive a MASA grant/scholarship, you are required to pay the program price MINUS your MASA grant/scholarship, with a minimum of US$ 1,600 (this is the scholarship deposit), in order to book a place in the program. So in any case you must make a first payment of at least US$ 1,600 – one month before the program start date at the latest. If your MASA scholarship is higher than US$ 1,600, we will refund the difference after three to four months into the program. </p><p>If you do not receive a MASA grant/scholarship, you are required to pay the full price before the beginning of the program.</p><p>Acceptance will not be confirmed until all documents and payment have been received. When our office receives your application, we will make every effort to place you in a program that will meet your requirements. Please note that in certain cases we might ask you for additional documentation or evaluation before final placement.</p><p>OTHER IMPORTANT INFORMATION:</p><p>Flights & Arrivals:  Participants must acquire their own flight ticket.  Participants must email their flight ticket to us before arrival.  Transportation to/from the airport is the responsibility of the participant.  When entering Israel, the participant will receive from the Border Police (Passport Control) a small blue note. KEEP IT IN A SAFE PLACE BECAUSE THE KIBBUTZ STAFF NEEDS TO MAKE A COPY OF IT!!! </p><p>Health Insurance:  The insurance is included in the program fee.  All participants are insured with medical insurance by PZC and the kibbutz only while on the program (starting from the earliest possible arrival date). If you arrive in Israel BEFORE that date, we strongly recommend that the participant arrange medical insurance until the start date of the program.  The insurance enables the participant to purchase medicines at a reduced price in the kibbutz infirmary.  If a participant needs a certain medicine on a regular basis, we recommend (s)he bring a sufficient supply for the entire period, or alternatively makes prior arrangements so that the medicine will be sent to him/her.</p><p>Kibbutz Program Center, 25 Broadway 9th floor New York NY 10004 Telephone: 212.462.2764. [email protected] http://kibbutzprogramcenter.net</p><p>PZC Hagshama  Once the program is over or if the participant chooses (or is asked) to leave early, they will no longer be covered by the program medical insurance. It is the participant's responsibility to buy adequate medical insurance!  PZC will not refund pre-existing medical conditions beyond what the insurance covers.  The participant will independently cover any additional costs.</p><p>Valuables : We are not responsible for any lost or stolen items and will not refund any of the above. We suggest you leave valuable belongings in the Ulpan safe or avoid bringing them with you.</p><p>Cell Phones: We recommend checking out the various deals by Israel Phones, Golan Telecom, Cellcom, Rami Levy, 012, Pelefon, etc. Purchase/hiring/use of any kind of phones/sim cards etc. are the participants' responsibility ONLY.</p><p>Form 1: KIBBUTZ ULPAN APPLICATION Last name (just ONE please) First name (just ONE please) Middle name(s) Date of birth (dd/mm/yy) Home Country & Passport Number Gender Marital status Religious affiliation (circle) Jewish (Secular Reform Conservative Orthodox) / Not Jewish Hebrew level Present citizenship(s) Highest Degree Occupation/Profession Address line 1 Address line 2 City Zip code Home phone Work phone Cellular phone Fax number E-mail address (of participant) E-mail address (of 1 parent/guardian) Estimated date of arrival 1. 3. Kibbutz preference (1. is most desired) 2. If you have indicated Na’an, Yagur, 1.Classic kibbutz ulpan Tzuba or Mishmar Ha’Sharon, are you 2.Internship opportunities interested in: (circle) From Masa Website From Masa Representative From Shaliach How did you hear about our program? From friend/family From Internet Advertisement From Program Website (circle appropriate answer) From a Fair Other:______Kibbutz Program Center, 25 Broadway 9th floor New York NY 10004 Telephone: 212.462.2764. [email protected] http://kibbutzprogramcenter.net</p><p>PZC Hagshama</p><p>DECLARATION I certify that I have read all of the conditions in this application package and that all information in this application is correct to the best of my knowledge.</p><p>______Signature of Applicant Name & signature of parent or guardian Date (Required if applicant is under age 18 on date of signing)</p><p>SEND ALL FORMS To: [email protected]</p><p>Kibbutz Program Center, 25 Broadway 9th floor New York NY 10004 Telephone: 212.462.2764. [email protected] http://kibbutzprogramcenter.net</p><p>PZC Hagshama Form 2 / PARTICIPATION AGREEMENT</p><p>I, the undersigned, understand that Masa grants/scholarships are granted for a full program of 5 months, and become available only after a minimum stay of 2 months. If I decide to leave early, or if I am expelled from the program, the grant/scholarship will be adjusted accordingly and so there will be financial consequences. I therefore agree to the following arrangements: Cancellation and Refund Policy: If you cancel... Masa Refund/ Required Payment up to one month before the start Grant/scholarship You owe us nothing: Full refund of paid sum minus transfer date of the program cancelled charges within one month before the start Grant/scholarship You owe us US$ 500: Refund of paid sum minus $500 OR date of the program cancelled payment of $500 (to be paid within 1 month of cancellation, if program fee has not been paid yet) If you leave the program... Masa Refund/ Required Payment Within 2 weeks from the start Grant/scholarship cancelled You owe us US$ 1,600 (scholarship deposit). date Refund if applicable. After 2 weeks, but within 2 Grant/scholarship cancelled You owe us US$ 2,750 (scholarship deposit, months and 1 day of program insurance, cancellation fine). Any financial debt is to be paid within ONE month of the cancellation. Refund if applicable. After 2 months and 1 day Grant/scholarship will be You owe us the full price of the program. reduced and granted only for including reduced sum from MASA number of months spent in grant/scholarship. In this case you may have to program send us additional money! No refunds!</p><p>Responsibility and Participation:  The Kibbutz and all related organizing and responsible organizations do not carry responsibility for the participants while on free time and away from the Kibbutz.  The participants are required to behave normatively, maturely, alertly and responsibly at all times  The participants are required to participate in all aspects of the program. Non-participation may result in expulsion. Rules and Regulations:  All participants are required to abide by the rules and regulations explained at the start of the program in each Kibbutz. Breaking rules and regulations may result in removal from the program.  Use of ANY kind of drugs is illegal and will result in immediate expulsion from the program.  There is a required deposit upon arrival to the Kibbutz of about 500 NIS (around 150 USD) for damage of Kibbutz property, or for unforeseen expenses which will be refunded after the Ulpan, assuming no damage has been done and no expenses were made. Refund of deposit is solely the Ulpan Director's decision. PZC- Hagshama is NOT responsible for refund or non-refund. Grounds for dismissal (determined by the Ulpan staff and/or Program Organizer)  Anti-social and/or destructive behaviour, as determined by program staff in Israel;  excessive or anti-social use of alcohol;  any use of or involvement with drugs or narcotics;  leaving Israel during the program without obtaining permission to do so;  not fulfilling responsibilities to the Kibbutz, including work duties and classes or to the program.</p><p>______Name & Signature of Applicant Name & Signature of parent or guardian Date (Required if applicant is under age 18 on day of signing) Kibbutz Program Center, 25 Broadway 9th floor New York NY 10004 Telephone: 212.462.2764. [email protected] http://kibbutzprogramcenter.net</p><p>PZC Hagshama</p><p>Kibbutz Program Center, 25 Broadway 9th floor New York NY 10004 Telephone: 212.462.2764. [email protected] http://kibbutzprogramcenter.net</p><p>PZC Hagshama</p><p>Form 3 / APPLICANT DECLARATION OF COMMITMENT</p><p>I, the undersigned applicant, have chosen to participate in the Kibbutz Ulpan Program of my own volition. I have read, understood and agree to be bound by the Statement of Standards and Responsibility (as specified in the Participation Agreement). I understand and agree that I must attend all work and study components of the program and that missing any of those is grounds for dismissal. Furthermore, I have read and understood the rules and regulations of the program and agree to follow them and those given to me upon arrival in my assigned kibbutz. I understand that I will not be able to switch kibbutzim once I have started the Kibbutz Ulpan Program. I understand that I will not be allowed to begin the program without paying the amount specified by the Organizer. I understand, and agree, that my signature (and if necessary, my parents'/guardians' signature) is legally binding and that I signed all relevant documents of my own volition. I understand that by signing the Participation Agreement I am legally bound to all the conditions in that agreement. I understand that without proper signatures on any or all documents, I will not be accepted to the program. I understand that without full payment or full payment arrangements, I will not be accepted to the program. I am aware of the fact that the medical insurance does not cover pre-existing health problems and any other incidental costs incurred, such as travelling to/from medical centers. Those expenses are solely my, the participant's, responsibility. I will work on the kibbutz and study Hebrew for the entire term of the program. I understand that I may be transferred to another kibbutz if the original kibbutz to which I have been accepted cancels its program. I understand and agree that in case I do not live up to my commitments, or if I am found unsuitable by the kibbutz, the kibbutz has the right to ask me to leave without assuming responsibility for any additional expenses incurred.</p><p>______Name & Signature of Applicant Name & Signature of parent or guardian Date (Required if applicant if under age 18)</p><p>Kibbutz Program Center, 25 Broadway 9th floor New York NY 10004 Telephone: 212.462.2764. [email protected] http://kibbutzprogramcenter.net</p>