Short Term Program Application Form

Applying for*

Land of the Bible Course
Special Programs

First Name*

Last Name*

Permanent Home Address*

Email Address*

Telephone*

(include country and regional codes)

I'm interested in attending courses*

in person
online via Zoom

Fax

Occupation*

Nationality*

Date of Birth*

Country of Birth*

Gender*

Male
Female

Status*

Single
Married
Divorced
Widowed

Number of Children*

Health Insurance is required for your stay in Israel. For pre-entry visa applications, insurance will be automatically provided through the Hebrew University with a required medical exam by a local doctor in your country. See attached HUJI medical form.

Describe any important medical concerns*

Contact in case of emergency*

Instruction: Please copy all information directly from the passport or other official document.

Name as it appears in the passport*

Passport number*

Place of Issue*

Date of Expiration*

Father's First Name*

Religion*

Mother's First Name*

Previous Last Name (if any)

Previous Stays in Israel

Dates	Passport Number

Date of Intended Arrival in Israel*

Date of Intended Departure from Israel*

Indicate which Israel Embassy is most convenient to pick up your visa (city)*

Decide carefully as this information is critical. The visa will be sent to this location ONLY.

Target Translation Language*

Size of Language Group*

Do you have one year of Biblical Hebrew studies or equivalent?*

Yes
No

Please describe your past, present, and projected activities in relation to Bible translation work and the potential benefits from this course.*

Undergraduate Studies

Name of Institution, City, State/Province, Country*

Major Field of Study*

Number of Years Studied*

Degree/Certificate received*

Date*

Graduate Studies 1

Name of Institution, City, State/Province, Country*

Major Field of Study*

Number of Years Studied*

Degree/Certificate received*

Date*

Graduate Studies 2

Name of Institution, City, State/Province, Country*

Major Field of Study*

Number of Years Studied*

Degree/Certificate received*

Date*

Graduate Studies 3

Name of Institution, City, State/Province, Country*

Major Field of Study*

Number of Years Studied*

Degree/Certificate received*

Date*

The following items are required with this application form.

Page of past, present, and future activities*

Max. file size: 50 MB.

One digital photo of applicant, of standard passport size and dimensions*

Max. file size: 50 MB.

Scan of passport picture page*

Max. file size: 50 MB.

Scan of marriage certificate

Max. file size: 50 MB.

#1 Academic or professional recommendation letter, written by someone with whom you have had an academic or professional connection*

Max. file size: 50 MB.

#2 Academic or professional recommendation letter, written by someone with whom you have had an academic or professional connection*

Max. file size: 50 MB.

I agree to be subscribed to JCBT’s English newsletters*

Yes, please.
No, thank you.

JCBT MEDIA RELEASE*

I agree to the JCBT Media Release
I do not agree to the JCBT Media Release

I, the undersigned, do hereby consent and agree that Jerusalem Center for Bible Translators, its employees, or agents have the right to take photographs and video and to use these in any and all media, now or hereafter known, and exclusively for the purpose of advertising. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I do hereby release to Jerusalem Center for Bible Translators, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback. I also understand that Jerusalem Center for Bible Translators is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

Signature*

Date*

Place*

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