Appendix E: Program Participant Liability
Israel Teaching Fellows

Masa Number:________________

Date: _____________

(Name and address of Organizer)

Authorization, Official Declaration and Liability

I, the undersigned, am participating in the “Masa Israel Teaching Fellows” Program organized by ___________ , (hereafter: ‘the Program’ and ‘the Organizer’), under the auspices of Masa Israel Journey (hereafter: ‘the Company’). Masa Israel is a joint initiative by the Government of Israel and the Jewish Agency for Israel.

I hereby agree, declare and accept that:

A. I will remain in Israel until the end of the Program. I will not travel abroad unless permitted to do so or during my free time during the course of the Program, in accordance with Masa Israel’s terms and the conditions laid down by the Organizer, and on condition that the vacation is not taken at the start and/or at the end of the program.

B. i) I understand that the duration of my vacation/time off during the Program will be according to the official school vacation times and Israeli holidays. This altogether amounts to more than 10% of the program duration, what other Masa program participants are allowed.

In addition I am allowed another 5 days off from school, subject to approval from my Program. Masa must be notified of these days. If I take time off for family visits to Israel, these days will be included in the additional 5 days permitted.

For any additional time over and above those defined above, special permission from Masa must be obtained in advance.

If I need to travel abroad for personal reasons, and be absent from school, special permission must be obtained from Masa and relevant documentation must be provided.

I understand that any deviation from the allowable vacation days will result in a review of my continued participation in the Program and/or may result in a reduction or cancellation of the monies awarded to me by Masa.

ii) I understand that I will be allowed up to 15 sick days, and no more than 3 days a month, during the Program. These sick days require a doctor’s letter and are subject to Program approval. Any deviation will require Masa approval. I accept that I will notify my coordinator the day before taking a sick day, or as soon as possible.

In special cases, if I am unable to take a reasonably active part in the ongoing Program activities that result in a sequence of absences and irregularity in attending school, Masa must be notified immediately.

I understand that any trip I may take abroad for medical treatment must be approved ahead of time by Masa and requires submitting relevant documentation to Masa. A decision regarding continued participation in the Program will be made on a case-by-case basis, taking into consideration the particular circumstances.

Deviation from allowed number of sick days may be cause for my continued Program participation to come under review and/or may result in a reduction or cancellation of the monies awarded to me by Masa.

iii) I accept that I will participate in all pedagogical training days in addition to Masa enrichment days. I understand that attendance of these days is mandatory and that release from any of them can only be in special cases and by special permission from Masa.

iv) I commit to 25 weekly hours in school in at least 4 working days per week. I understand that I am entitled to one weekly day off according to my personal work schedule and with prior coordination with the school and my Program.

C. In order to attend the Program I will pay a program fee of $1,000. The rest of the Program’s costs will be covered by Masa Israel, the Government of Israel and the Jewish Agency for Israel, as described in section H. This includes a reimbursement of airfare of $1,300 that will be refunded subject to completion of the program and will be done some time after the program finishes. Birthright participants will need to submit their ticket.

D. I am aware that if I decide to leave the Program after being in Israel before the end of the program, I will not be eligible for airfare reimbursement as detailed in section C, and I will commit to returning in full the cost of the training program I will take part in.

E. I will convey to the Organizer, in writing or verbally, all relevant information pertaining to my legal status in Israel. I will provide all necessary documents attesting to my status. I will also advise the Organizer of any change in my legal status.

F. I will participate fully in all activities, meetings, tours and hikes included in the Program, especially (but not only) main Masa Israel events, as determined by the Company.

G. I am aware of all my obligations, privileges and limitations regarding my stay in Israel during the Program, especially (but not only) as they pertain to safety and security instructions. This applies equally whether I am on campus (or another base of activities), on hikes, during my free time, at organized host family events, or during travel and visits abroad, in accordance with Appendix D in the information pamphlet provided by the Program Organizer.

H. I am aware that the Company and the Government of Israel, through the Prime Minister’s office and the Ministry of Education, are sharing in the Program costs, and that the Company receives its funding from the Government of Israel and The Jewish Agency for Israel.

I. I am aware that the Company is not obligated to assist me financially, even if I successfully complete all the necessary requirements. In the event that I apply for financial assistance, the Company has the sole right to decide whether or not this assistance will be granted.
Additionally, I am aware that I may only apply for a grant, and not for a needs-based scholarship.

J. I am aware that the Company has no responsibilities or obligations to me with regards to academic and/or other credit for the Program.

K. I am aware that if I breach any of these terms I will not be entitled for any financial assistance; and the Organizer will pro-rata refund the Company all monies that were paid to the Organizer for my participation in the Program. The Company and/or the Organizer has the right to demand and receive from me the full amount of financial assistance that was paid to the Organizer on my behalf, which was provided as a discount for my participation in the Program.

L. I am aware of the following deadlines in applying for Masa Israel grants and scholarships:
For any request for financial assistance I must submit my passport number no later than the Program’s halfway point, or I will lose my eligibility for financial assistance.
Requests for grants must be submitted no later than the Program’s halfway point.

M. I am aware that if I participate for a period of less than 2 months – I will not be entitled for any financial assistance. If I leave the Program after a period of less than two months for any reason, I will refund the Program any monies paid by the Company to the Program and costs incurred by the Program for my participation, as requested by the Program.

N. I am aware that if I change my status to become an “Oleh” (immigrant) during the course of the Program, my financial assistance will be reduced and pro-rated according to the period before the status change.

O. I acknowledge that details of my participation in the Program will be transferred by the Organizer to the Company.

P. I agree to allow Masa Israel and/or any other who is authorized to request in the name of Masa Israel, to turn to the Ministry of Interior of the Government of Israel and/or other official relevant authorities, so as to obtain information of my status in Israel, and in general, as it relates and pertains to my date(s) of entry(ies) to Israel and/or date(s) of departure(s) from Israel.

Q. I am aware that neither the Company, nor the Government of Israel, nor the Jewish Agency can in any way be held responsible for and have no obligation towards my participation in the Program and/or any other matter that pertains to this agreement. I hereby waive all complaints, demands and/or claims relating to the above. Should I decide nevertheless to submit a claim to the Company, the Government of Israel, or the Jewish Agency, I will reimburse them in full for any amount they are required to pay for damage or loss incurred by them as the result of my claim and/or as the result of breaching or otherwise failing to comply with the terms of my commitment as laid out here and/or according to law. This compensation will also extend to any legal costs and expenses that are incurred for any of the above reasons.

R. I am aware that receipt of financial assistance is subject to the Organizer signing an agreement with the Company and to the Organizer’s compliance with the provisions of that agreement.

S. I am aware that if the combined amount of financial assistance from both the Company and other financial sources exceeds the cost of the Program (including the cost of food and board), the Company may offset the difference between the cost of the Program and the total amount of financial assistance I am entitled to from the financial assistance I am entitled to from the Company.

T. I accept that inappropriate behavior, drug usage, violence, endangering of other participants or myself, any criminal offence, and any out of the ordinary disciplinary problem will result in my immediate removal from the Program and/or may result in the reduction or cancellation of the monies awarded to me by Masa.

U. I give Masa permission to:

o Share the information in my application form with donors, the Government of Israel, the Jewish Agency and my Program Organizer.

o Use photos taken of me at Masa and Masa-affiliated events in its publications, press releases and/or on the Masa website.

o Use my e-mail, home address or phone number to contact me.

I declare that the information I have given in this Application Form is true and complete.

I understand that if this application contains inconsistencies or inaccurate information, a review may be conducted of any monies awarded and may result in the cancellation of my Masa Israel funding.

I have read, understood and accept all the terms of this document.

___________________                     ___________________
Name of Participant (print)         Signature of Participant

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