Reference 1

Reference 2

DECLARATION

TRAINING PROGRAM                                                                                 Date______________

I, the undersigned, Mr./Mrs./Miss                                                                  of (country) ________

in submitting my application for study and/or training in Israel as described earlier, declare as follows:

(A) I UNDERSTAND that it is the intention of the government of Israel to enable me, if I should be found suitable, to participate in a period of study and/or training in Israel as part of the cooperation between the Government of Israel and my country.

(B) I AM FULLY AWARE that the training opportunity given to me is designed for the benefit of my country’s development. I, therefore, pledge to participate fully in all studies offered and to comply with all regulations established by the professional institution hosting the training program.

(C) I CLEARLY UNDERSTAND that the purpose of my visit to Israel is to study and/or train. Therefore I will refrain during my stay in Israel from engaging in any political activity and/or gainful employment.

(D) I AM FULLY AWARE that my stay in Israel may be discontinued if I should commit any infraction of my undertaking in this declaration, and/or of the Israel civil or criminal law, and/or break the rules and regulations of the school or institute where I will be studying and/or training. 

(E) I UNDERTAKE to return to my country upon the completion of my studies, as stipulated by the Government of Israel and the supervisors of my training program.

(F) I UNDERSTAND that the Government of Israel cannot in any way be held responsible for the material needs of my family during my stay in Israel, nor for my employment upon my return to my country.

(G) I AM FULLY AWARE that the legal, financial, and moral responsibility of the Government of Israel ends with the conclusion of the training program.

(H) I AM - to the best of my knowledge - of healthy body and mind and do not require any medical treatment or attention.

(I)  I UNDERTAKE to submit to a further medical examination before or during my studies when required to do so by the Government of Israel.

(J)  I AM FULLY AWARE that the institute does not bear any responsibility whatsoever for my money, valuables, documents etc. Similarly, the institute bears no responsibility whatsoever for loss of money, valuables, documents, etc.

(K) (FOR WOMEN) I AM NOT - to the best of my knowledge - pregnant, and I understand that I am liable to be sent home in case of pregnancy.

(L) I UNDERSTAND that the organizers do not accept any responsibility for the treatment of chronic diseases, dental treatment or eye glasses during my stay in Israel.

(M) I ALSO UNDERSTAND that my personal belongings are not insured by the organizers.

(N) I HEREBY CERTIFY that all information and documents presented are correct and truthful.

(O) I AM FULLY AWARE that it is my responsibility to obtain the name and location of the Israeli institute to which I am going, its address and how to arrive there.

(P) I UNDERSTAND that all the financial arrangements have been finalized with the Israeli Representative before my arrival in Israel.

(Q) I FULLY UNDERSTAND that, unless stated otherwise, the insurance policy under which I shall be insured by the Israeli institute covers me only during the period of the course/program within the area of the State of Israel.

I confirm hereby my full agreement to these conditions.

Signature of applicant ___________________________________                                                                          

Date _______________ Place _____________________________            

Please write a short paragraph describing your expectations from the training program including the direct contribution of the program to your field of work, as well as future plans after completion of the program.

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Please write a very short autobiography

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To be filled out by applicant:

To be filled out by Family Physician/ Practitioner: