Eastern Mediterranean International School Foundation

Reg. Foundation No. 580179851 |

+972-54-4674629

www.em-is.org |

Kfar Yarok, 4780000, ISRAEL

Applicants information: Surname: ID number: Address: State: Name of School: Given name: Grade: City: Country: School location:

Postal Code:

SECTION A - to be completed by the applicant (please use capital letters and black ink) 1. 2. 3. 4. 5. Family Name .. Personal Name(s) .. Date of Birth: Day Month Year Number of Siblings Sex M / F Nationality (ies) (please specify all) Country of Birth Year of Immigration to Israel (if applicable) 6. 7. First (native) Languages Other Languages Home Address.. City . State: Zip Code Country ... Tel.No. Mobile No. .

E-mail address . 8. Present School Years of Attendance . Address City . State: Zip Code Tel.No.. 9. How did you hear of EMIS? (tick all appropriate) Via another organization (detail) ____ Advertisement (detail) ____________

School representative visit __ Friend or relative __ Other (please detail) __________

Page 1 of 4

| To make education a force for peace and sustainability in the Middle East

Eastern Mediterranean International School Foundation

Reg. Foundation No. 580179851 |

+972-54-4674629

www.em-is.org |

Kfar Yarok, 4780000, ISRAEL

SECTION B - to be completed by the applicant 1. Do you plan to study in university? . If yes, do you know what you would like to study? (detail) . 2. What is your philosophy of life? (20 words or less) .. .. .. 3. What sports do you do regularly? (detail) 4. What arts do you do regularly (visual arts, music, etc)? (detail) .. .. .. 5. Have you volunteered or been active with a social service? (detail briefly) .. 6. Detail offices/positions that you have held in school organizations. .. .. 7. Describe activities and organizations in which you have been active outside of school .. .. 8. Describe other accomplishments you would like to share with us. . .. .. .. .. 9. Is this the first time you are applying to EMIS? Yes .. No .

Page 2 of 4

| To make education a force for peace and sustainability in the Middle East

Eastern Mediterranean International School Foundation

Reg. Foundation No. 580179851 |

+972-54-4674629

www.em-is.org |

Kfar Yarok, 4780000, ISRAEL

SECTION C - to be completed by the applicant.

1. Write three essays on the subjects listed below (attach separate clearly marked pages for each essay): a. Why are you applying to EMIS and what do you expect to learn and experience from the time you will spend at EMIS? (100 words please mark keywords at end of essay)

b. Ask and answer one open/free question you would ask yourself. (350 words please mark keywords at end of essay)

c. Choose one of the wishes below and write an essay about it: (1) If you could be another person for 24 hours, whom would you choose and why? (2) Choose an event from the past year that influenced you and detail its significance and how you relate/d to it. (3) Imagine that you have received $1 million US Dollars to create and/or initiate a new project in Israel. Describe what its goals would be, how you would design it and include an outline of a budget for the project.

Page 3 of 4

| To make education a force for peace and sustainability in the Middle East

Eastern Mediterranean International School Foundation

Reg. Foundation No. 580179851 |

+972-54-4674629

www.em-is.org |

Kfar Yarok, 4780000, ISRAEL

SECTION D - to be completed by the applicants Parent(s) or Guardian(s) 1. Full Name of Father or Guardian.Nationality Full Name of Mother or GuardianNationality 2. Address... 3. Day-time telephone number(s) for contact with parent(s) or guardian(s): Father/Guardian . Mother/Guardian . 4. Please enclose a medical statement from your doctor indicating the state of your sons/daughters physical and mental health. Please note that the school will accept

applications from candidates who have known handicaps over which they have control and which will not deteriorate significantly while they are the EMIS. 5. Is there anything of special note that you would like to bring to the attention of the Selection Committee or the School Head (a separate letter may be enclosed)? 6. We have read the application for scholarship entry to EMIS made by my son/daughter/ward: we have discussed all aspects of the commitment involved and this application has our full approval. We understand that under the terms of the EMIS' scholarship policy parents may be asked to make a financial contribution to the costs of attendance, and if our son/daughter/ward is accepted, we shall make an agreed contribution to the scholarship costs. Should the application be successful, we hereby undertake for ourselves and for him/her to observe the rules and regulations of the school made or to be made by the Head and Governors. While our son/daughter/ward is in residence at the EMIS School, we wish and authorize the school to act as Guardian in our place for decisions involving his or her personal care and welfare.

Signature of Father/Guardian.. Date Signature of Mother/Guardian.... Date

Page 4 of 4

| To make education a force for peace and sustainability in the Middle East