Eco-Israel Application Form
About the Eco Israel Program at Hava ve Adam Eco-farm:
Eco-Israel is a 5-month residential working/learning program in an Ecological Education Centre and Organic Farm in central Israel. Participants experience first-hand what it is like to live sustainably by growing their own food, getting closer to nature, working with the land and being part of a community.

Participants will learn to gain a different perspective on life and themselves through different workshops in agriculture, herbal medicine, mud-building, living in community, trips around Israel and more. You will also be eligible to receive a certificate in Permaculture Design Course upon completion of the program.
Email address *
Apply for the MASA Grant
The total cost of the program is 6,900 USD. if you are eligeble, please go to http://masaisrael.org/grants/apply to apply for the MASA Grant on their website! There are amazing scholarships available!
Questionnaire
I want to apply for the Eco-Israel program of: *
Full name: *
Your answer
Gender: *
Date of Birth *
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Passport Number: *
Your answer
Phone number, including the net number of your country: *
(+1 for USA, +31 for The Netherlands, +972 for Israel, etc.)
Your answer
1.What is your connection to Israel and what is your relationship to Judaism? Please discuss your previous experience with Israeli culture, the Hebrew language and Jewish identity, as well as what you expect to learn and experience during your time here. *
Your answer
2. What interests you about working on an Ecological Farm? Do you have any previous experience? Tell us if so, and/or your relationship with nature in general. *
Your answer
3. Have you had any experiences living in an intentional community (other than your family)? Share with us your past experiences - what you have learned as well as what difficulties you encountered - and what interests you in joining the Eco-Israel community. *
Your answer
4. List any skills, hobbies, or special interests, as well as anything else you would like to share with us about yourself. *
Your answer
Emergency Contact and Health Information
You must have health insurance to participate in Eco-Israel. While it might be possible to add an international/travel rider to an existing health insurance policy, it is often much easier to simply get a separate insurance plan for your time in Israel.

We highly recommend the Harel-Yedidim (or another Israeli insurance plan) because they do not require you to pay up front and then get reimbursed by the health insurance provider. .

Regardless of which insurance plan you decide to use, you must send us a copy of your policy BEFORE YOU ARRIVE AT THE FARM. Please contact the health insurance company directly with any questions about their policies.

HAREL-YEDIDIM (Israel) health insurance costs about $1.5/day. Have a look at http://www.yedidim-health.co.il. and click on Student plans.
5. Health Insurance Company & Policy Number:
Your answer
6. Emergency Contact Name: *
Your answer
7. Emergency Contact Phone Number: *
Include the country code in the phone number please.
Your answer
8. Emergency Contact Email Address: *
Your answer
9. Relationship of Emergency Contact to you: *
Your answer
10. If you also have an Emergency Contact Person in Israel, please write down their name, phone number, email address and their relationship to you below.
Your answer
11. Bring a Friend Discount! You will get a $250 discount on the cost of the program for every person that you recruit. Do you have a friend that might be interested in doing the Eco-Israel program as well? Please write their email address below.
Your answer
Eco-Israel ♦ Hava & Adam Eco-Educational Farm ♦ P.O. Box 1662, Reut 71799 ISRAEL Telephone in Israel: +972-8-622-5779 eco-israel.org
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