FRM_STUDEAN16_EN

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Please read and follow these guidelines:

1. The committee convenes once a month.
   
2. Applications are considered by a committee composed of the Dean of Students, the Director of the Dormitories, and a representative of the dormitory administration.
   
3. Committee decision is sent by email.
   
4. To ensure that the committee can consider your application, please provide full information. Incomplete applications will not be considered.
   
5. The committee may decide to request information from your academic unit.
   
6. In certain cases, before convening, the committee may request further information from you.
   
7. You may include official documents in support of your application (e.g. academic certificates, certificate from the Committee for Teaching Affairs, medical documents).
   

Please write to Raziel Bargil if you have any questions razielb@savion.huji.ac.il

Please fill in the required details

First name:

Last name:

ID number/student ID number:

Name of dormitory in which you currently reside:

Number of year of residence in Univesity dormitory:

Academic programs:

Academic year

Department A

Department B (mark X if not applicable)

Degree

School

Graduated

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Comments

Do you intend to declare intention to graduate this year

Yes No

Specify the remaining courses/acaemic assignments (in order of appearance in your transcripts) before graduating:

Specify your reason for continuing to reside in the dormitory :

Enclose transcripts (for the last 3 years at least):

No file selected

Enclose additional documents:

No file selected

I confirm that I have the read the regulations above