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Personal Information

Name
Date of Birth
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Marital Status
College Address
Permanent Address
Father's Name
Mother's Name
Parent's Address

Academic Information

Semester Taken
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Signature (type your name)

Passport Information

Expiration Date

Medical History and Information

Please identify the existence of any of the following medical conditions, the approximate age of diagnosis, and the treatment of the condition.

Applicants with a condition noted by an asterisk are REQUIRED to consult with their physician as to the feasibility of participation. Those applicants who identify such conditions are required to provide a medical clearance (a doctor’s written permission) as a prerequisite to participation in the IBEX program. The IBEX program is physically demanding and may exacerbate pre-existing medical conditions.

For any of the following questions, if the answer is YES, please provide an explanation:

if yes, please explain

I hereby give my permission to The Master’s University representative in charge of the IBEX program in Israel to select a physician, to hospitalize, to secure proper treatment, to order injections, anesthesia, or surgery for me in case of an emergency.

Signature
Date

Academic and Dietary Accommodations Acknowledgement

Signature (type your name)

Insurance Information

Company Address

It is important that the participant recognize that in Israel, medical and hospital bills must be paid in full before the patient will be discharged. The Master’s University is not responsible for covering medical expenses while abroad. Participants should have a credit card or contingency fund to cover unexpected treatment. *Any participant who does NOT in fact have insurance coverage overseas is required to obtain this prior to departure for the IBEX semester. Please feel free to contact the IBEX office for recommendations.

Emergency Information

Contact's Name
Contact's Address

Testimony

What You Need to Know about the Application Process, the List, and the Waitlist

Please Read Carefully

1. Application Process

a. Once you turn in your IBEX application, $50 fee, RD recommendation, and doctor’s notes (if required; see medical section), your application will be submitted to the IBEX directors for approval.

b. Once you are accepted into the program, you will receive an email from the IBEX secretary.

c. IBEX reserves the right to terminate your acceptance at any time if you fail to meet the requirements listed in this form (GPA, RD Recommendation, Medical Concerns, or Academic Concerns).

2. The List

a. Your spot on the IBEX list is reserved by acceptance date. The sooner you apply the better!

i. Application date is determined by when you turn in this application, your $50 fee, any doctor’s notes required, and your RD recommendation.

ii. Once all items have been submitted then your application will go to the IBEX committee for review.

iii. Your spot will not be reserved until you have been officially accepted to IBEX. 

b. The List is tentative and subject to changeThe list will fluctuate up and down until about the semester prior to your semester. Please do not be concerned if you move down; sometimes people switch semesters. Their spot is determined by acceptance date, just like yours.

c. The List is updated as changes accumulate. To see an updated list, please check Content Management -> IBEX Student List.

d. Due to housing restrictions, there is a 20 person gender cap. In other words, we can only take 20 men or 20 women maximum per semester.

3. The Waitlist

a. IBEX usually has 32 spots available each semester. If you apply after those 32 spots are filled, you will be placed on the waitlist.

b. If you apply after the gender cap is reached (see section 2d above), you will be placed on the waitlist.

c. The waitlist is sorted by acceptance date, just like the regular list.

d. An acceptance letter to IBEX does not contradict the waitlist. You can be accepted and on the waitlist.

e. Seniors will be moved to the top of the waitlist in October (Spring) or March (Fall).

f. IBEX cannot guarantee waitlisted students a spot on the list. Generally, the chances of the waitlist moving up are good until 4 months prior to your semester. Please ask the secretary if you have questions about your chances of making the list.

4. Acceptance

a. Your acceptance to IBEX is based on your current GPA and RD Recommendation and is therefore subject to change.

i. Your GPA will be checked before you go to Israel. If you’ve fallen below the 2.9 requirement, you will not be allowed to go to IBEX.

ii. RDs can change their recommendations at any time. They will be asked to reconfirm your recommendation four months prior to your departure. If they indicate that IBEX would not be a good fit for you, you will not be allowed to go to IBEX. 

b. Please remember that IBEX is not a right; it is a privilege.


Acknowledgement of Risk and Assumption of Liability

Please Read Carefully

In order to participate in the IBEX Program, the undersigned agrees to and acknowledges the following:

1) International travel invariably has its hazards and risks, particularly in countries where standards of health, sanitation, public safety, etc. are different than the United States. The undersigned recognizes that The Master’s University has made every effort to ensure participant safety, but that certain factors are beyond the control of The Master’s University, including, but not limited to, air travel and land operations.

2) The undersigned agrees to waive and release The Master’s University, an independent corporation, and all persons and entities in interest with The Master’s University, including administrators, faculty members, staff members, and other employees, agents, and representatives of The Master’s University, of and from any and all claims, actions, or suits, for personal injury, death, property damage, or loss sustained by the undersigned in connection with the IBEX Program.

3) The undersigned understands that The Master’s University and/or the course director has the authority to establish rules necessary for the operation of the program, and that should the director decide that a student must be separated from the program because of violation of such rules, for disruptive behavior, or for conduct which could bring the program and/or college into disrepute or danger, that decision will be final. All loss and expense incurred in the event of the termination of the undersigned’s participation in the program, including the cost of travel, must be borne by the undersigned.

4) The undersigned understands and agrees that The Master’s University is not responsible for cancellation or changes in travel and program schedules or adjustments in announced fees for the program caused by changes in air tariffs, lodging rates, or fares charged by those engaged for such services. The undersigned further agrees that in the event of an act of war, terrorism, act of God, or other emergency, which causes this program to be canceled in whole or in any part, any refund due the undersigned will be determined by The Master’s University at its discretion.

5) The undersigned understands and agrees that The Master’s University is not responsible for medical expenses if the undersigned requires medical treatment during the undersigned’s participation in the program. If the undersigned is physically incapacitated for medical reasons, the undersigned agrees that The Master’s University, or its representatives, may make arrangements for the medical care of the undersigned in emergency circumstances and any such medical expenses are the responsibility of the undersigned. Furthermore, the undersigned agrees that he/she has in effect a policy or policies of medical and hospitalization insurance providing medical and hospital expense benefits, and that the policies are in full force during the time period in which the undersigned is a participant in the program.

6) The undersigned recognizes that the program can be physically rigorous. The course director(s) reserve the right to limit, or restrict, participation in the course or certain course activities of individuals who, in the estimation of the course director, may endanger themselves, or hinder the program. The undersigned agrees to comply with all directives by course directors.

7) The undersigned recognizes that the deposit fee is non-refundable or transferable.

There is a $50 deposit required at application. Please bring it in or mail it to

IBEX Office Box #16
21726 Placerita Canyon Road
Santa Clarita, CA 91321

Please make all checks out to The Master's University.

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