INTERNATIONAL STUDENT EXCHANGE PROGRAM
STUDENT APPLICATION

PLEASE PRINT OR TYPE (USE BLACK INK)

NAME:       [   ] MALE                 [   ] FEMALE
COUNTRY OF  CITIZENSHIP:	PLACE OF BIRTH: (CITY, COUNTRY)
PASSPORT NUMBER AND EXPIRATION DATE:						DATE OF ARRIVAL:
COLLEGE OR  UNIVERSITY:						DEPARTMENT:
CURRENT MAILING  ADDRESS:						TELEPHONE: (      )
PERMANENT  ADDRESS:						TELEPHONE: (      )
CURRENT EMPLOYER NAME AND ADDRESS:						TELEPHONE: (      )
FAX NUMBER:						E-MAIL ADDRESS:
PERSON TO BE NOTIFIED IN EMERGENCY:						TELEPHONE: (      )
DESCRIBE THE TYPES OR FIELDS OF WORK IN WHICH YOU HAVE A PRIMARY INTEREST. ALSO, THOSE IN WHICH YOU HAVE A SECONDARY OR MORE GENERAL INTEREST:
COLLEGES AND UNIVERSITIES ATTENDED NAME & LOCATION		FROM	TO	DEGREE/DATE	CLASS STANDING		MAJOR FIELD	MINOR FIELD
PRESENT
LIST PROFESSIONAL ORGANIZATIONS, HONORARY SOCIETIES, ETC. OF WHICH YOU ARE A MEMBER:

WHICH COUNTRY DO YOU WANT TO APPLY TO?
 
 

WHICH PROJECT?
 
 

DESCRIBE PREVIOUS WORK EXPERIENCE WHICH MAY ASSIST IN SELECTION OF YOUR ASSIGNMENT:
 
 
 
 

WILL FAMILY MEMBERS BE ACCOMPANYING YOU OR JOINING YOU LATER?            [   ] YES                           [   ]  NO

(IF YES, PLEASE PROVIDE NAME (FAMILY, GIVEN, MIDDLE), DATE OF BIRTH, COUNTRY AND CITY OF BIRTH, CITIZENSHIP AND RELATIONSHIP:
 
 
 
 

HAVE YOU HELD A PREVIOUS APPOINTMENT ABROAD?                        [   ] YES                            [   ] NO

(IF YES, STATE TYPE OF APPOINTMENT, SUPERVISOR, DIVISION AND TIME PERIOD.)
 
 

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