Start Up CampApplication Form

PERSONAL DATA:

First Name: / Family/Last Name: / Gender:Choose oneMaleFemale
Address:
City: / State/Province: / Zip:
Country: / Your e-mail:
Parent’s name: / Parent’s e-mail:
Your mobile phone: / Parent’s mobile phone:
Tel: / Prefer method of contact:Email Mobile Tel
Birth date (DD/MM/YYYY) : / / / This year I am a student in th grade.
Nationality & Passport Number (Non-Israelis):
ID (Teudat Ze'ut) Number: (Israelis):

HIGH-SCHOOL:

School Name:
Address:
City: / Zip: / State/Province: / Country:
School Telephone:
Principal's Name:

How did you learn about this Summer camp?

Technion web site / From a former participant / Through school / The Jewish Agency
Israeli Foreign Ministry / Technion Society / Other:

Personal information for our evaluation:

This section is designed to help us evaluate your profile fitness to program demands. Please answer in the appropriate place.

  • All answers should be typed; applications in hand writing will not be considered.
  • Please enclose one typed recommendationby someone you consider appropriate to recommend you for a challenging start up camp. Recommendations should be typed and added to the application. The recommendation can also be sent separately from the school.
  1. Linguistic skills: please rank your ability on a scale of 1 to 4 where 1 = poor, 2 = fair; 3 = good; 4 = fluent.

Understand / Speak / Read / Write
English / Choose one1234 / Choose one1234 / Choose one1234 / Choose one1234
Hebrew / Choose one1234 / Choose one1234 / Choose one1234 / Choose one1234
Other: / Choose one1234 / Choose one1234 / Choose one1234 / Choose one1234
Other: / Choose one1234 / Choose one1234 / Choose one1234 / Choose one1234
  1. Grades: write the grade of the following classes (in case you did not take this class , do not mark any grade)

Grade 11th year / Grade 10th year / Grade 9th year
Math
Physics
Chemistry
Biology
Engineer (robotics, electronics...)
  1. Please attach your high school transcripts from the last two years
  2. PSAT (USA only) Math: Verbal:
  1. If a standard test for college\university exists in your country and you took it, please write the name of the test and the grade you received out of the maximal grade.
    Name of test: Score: Out of:

Please write a one page essay on one of the following:

  1. A list of any social/entrepreneurial/ business related activities in which you have participated, especially those that demonstrate maturity, social skills and leadership potential
  2. Who do you look up to/ Who are your idols in the entrepreneurial world?
  3. Do you have any special idea which you would like to pursue based on what you learn in start up camp? Please share with us
  4. Did you ever come with an idea and manage to work it out into a real entrepreneurship?