Please submit the following information:
First name: M.I.: Last name:
Name as it appears in your passport: Date of Birth
Address Line 1: Address Line 2:
City: State: Zip:
Telephone: Fax:

Academic rank/title:
Department: Division:

1. How did you hear about this program?

2. In the space below, please provide a brief (no more than 400 words) description of your research interests:

3. Do you have tenure?



4. Have you previously been to Israel?



5. Please provide a brief history of your past professional or personal travel to Israel or the Middle East.

6. Have you collaborated on research and writing in a field of common interest with Israeli colleagues? If so, please describe and provide the names of those colleagues.

7. If you have not yet collaborated with Israeli colleagues but would like to do so, please indicate the relevant discipline(s) and any relevant Israeli scholars you know by name (please include their discipline and institutional affiliation) with whom you might like to collaborate.

8. Please attach your Curriculum Vitae:

Types allowed: .txt, .pdf, .rtf, .doc, .docx — Maximum size: 500 KB

9. Please submit a recent photo to accompany your application:

Types allowed: .jpg, .jpeg, .png, .gif, .bmp — Maximum size: 500 KB

10. Please indicate your acceptance and understanding of the statements below:
If you are chosen as a participant for the 2013 FF2Israel program, you agree to submit a post-program report upon your return from Israel, and no later than July 30th 2013.

As programs usually involve walking on unleveled terrain, and due to safety issues, it is requested that all applicants make us aware of any conditions that may impede your involvement at the time of registration.

Upon acceptance, all FF2Israel 2013 participants will be required to provide a check for $250 — an airfare cancellation fee in the event they are unable to attend the program. All participants who attend and complete the program will be refunded the $250 cancellation fee.

 In Partnership with:

Faculty Fellowship Summer Institute in Israel . 42 East 69th Street NY, NY 10021
Ph: 646.459.3796 . info@ff2israel.org