For bachelor’s degree (first degree) holders from an academic institution recognized by the Council for Higher Education (CHE) – Direct Track

Application Form for doctoral degree – 2016-2017 academic year through the Dr. Miriam and Sheldon G. Adelson School of Graduate Studies at the Sackler Faculty of Medicine

1. First name: ______Surname: ______ID No. ______

2. Address:

Street No. City Postal code

3. Home telephone: ______Mobile: ______

4. E-mail: ______

5. I am interested applying as a candidate for the following track:

¨ Direct doctoral track (for bachelor’s degree holders)

¨ Outstanding students’ track for doctoral degree

6. Name of doctoral degree advisor: ______Department/faculty: ______

Location ______

7. Education:

Bachelor’s degree – field / Institution / Year graduated / Grade point average
Topic of final project (if any) / Name of project advisor / Project grade*

* Please attach confirmation of project grade or see that it is noted in the grade transcript

8. Attached are copies of scientific articles (circle one) Yes / No

9. Names of researchers who can serve as references of your ability to engage in research during your advanced studies (please send two written recommendations directly to Silvy Degani at .

1) First name and surname: ______Institution and department ______

2) First name and surname: ______Institution and department ______
10. On the attached page you must write a research statement. Please make it brief and well-written and do not exceed the page allotted for this. The statement shall be submitted printed in 12 pt. font (in Hebrew or in English).

You will be required to present the research proposed in the research statement during your admission interview.

During the interview you will be asked to present the research project you carried out, followed by a discussion and questions pertaining to your research project.

Therefore, you should prepare a brief presentation that describes your research project in five minutes. The last slide in your presentation should refer to future research plans as set forth in your research statement. Please note, your assessment by the admissions committee will also be based on your ability to keep to the schedule.

11. I hereby authorize the transfer of my registration information from the outstanding students’ track to the regular track in case I am found suitable (Circle one):

Yes / No

Applicant’s signature Date


Name of applicant:

Research Statement

Area of research you are interested in pursuing:
Explain the research project you wish to present at the interview (research goal, research question, methodology, possible results. Indicate another research approach that would advance your research.)
Explain your background, career goals and how the doctoral program will help you reach your academic goals:

* The research statement should be submitted printed in 12 pt. font, in Hebrew or English.

You may use the above form or print it out in the same number of rows, maximum of 1 page.