Application for Evergreen Exchange Programs

*** PLEASE PRINT ***

Name: / Phone:
Student ID number: / Email Address:
Birth Date: / / / / Receiving Financial Aid? / ☐ Yes ☐ No / Receiving Pell Grant ? / ☐ Yes ☐ No
Current Class Level: / ☐ FR ☐ SO ☐ JR ☐ SR ☐ GR / Expected Graduation Date:
Current Academic Emphasis: / Total Credits Earned So Far:
Have you ever been on academic warning? / ☐ No ☐ Yes / If yes, when?
Do you have any disciplinary history at Evergreen? / ☐ No ☐ Yes / If yes, what/when?

Indicate the Exchange Program you are applying for:

☐ University of MiyazakiMiyazaki, Japan Oct 1 - Aug 31Deadline to Apply: Feb 1

☐ University of HyogoKobe, Japan Apr 1 – Mar 31Deadline to Apply: May 1

☐ Daejeon UniversityDaejeon, South Korea Fall SemesterDeadline to Apply: Mar 15

Spring SemesterDeadline to Apply: Sep 1

☐ University of RoskildeRoskilde, Denmark Fall SemesterDeadline to Apply: Mar 15

Spring SemesterDeadline to Apply: Aug 1

☐ Xing Wei CollegeShanghai, China Fall SemesterDeadline to Apply: Mar 15

Spring SemesterDeadline to Apply: Oct 1

☐ UW Jackson SchoolSeattle, WA, USA Sep 15-Jun 15Deadline to Apply: Mar 15

(Officially a consortium)

Please estimate and check your current level of target language ability according to the scale below:

Target Language? / ☐ 0 / ☐ 1 ☐ 2 ☐ 3 / ☐ 1 ☐ 2 ☐ 3 / ☐ 1 ☐ 2 ☐ 3
None / Beginning Levels / Intermediate Levels / Advanced Levels
Describe your plans for developing your target language skills prior to participation in the program.

List the two people you plan to request recommendation letters from:

Name: / Relationship:
Name: / Relationship:

Please include the following required items along with this application. Remember to sign and date your application below.

☐One-page letter of interest, single spaced, indicating your reasons for applying, your goals, why you feel you are

prepared, any projects you will undertake, and any indicators of maturity, responsibility, and leadership.

☐Two signed recommendation letters from those listed above, either in sealed, signed envelopes, or sent directly

via email. The standard recommendation forms included may also be used.

☐Unofficial Evergreen transcript, or if you do not yet have one, official transcripts from other institutions where

you earned 45 or more credits.

☐A printout of your Academic History from your my.evergreen.edu account.

☐One academic writing sample, 5-10 pages long, that shows research, analysis, or argument. No creative writing.

☐An additional Language Assessment Form is currently required for programs in Japan.

☐The Review Committee may also request an interview with each applicant, at their discretion.

______Date: ______

Student Signature

Return completed form and required items to:

International Programs & Services • LIB 2153

The Evergreen State College

2700 Evergreen Parkway NW

Olympia, WA 98505

Fax: 360-867-5343•

Office Use: Academic Warning □Disciplinary Record □Academic History □

Evergreen Exchange Programs Recommendation Form

☐ Daejeon University, Daejeon, South Korea☐University of Miyazaki, Miyazaki, Japan

☐University of Hyogo, Kobe, Japan☐Roskilde University, Roskilde, Denmark

☐ Xing Wei College, China☐ University of Washington Jackson School

Name of Student:
Recommender’s Name:

The above student is an applicant to the Evergreen Exchange Program listed above. This program will entail one or two semesters of overseas study and the ability to liverelatively autonomously. Participants must be highly motivated, emotionally mature, resilient over an extended time, and able to adapt easily to people with different social and cultural backgrounds. In addition, students are representatives of the Evergreen State College and participate in presentations about American culture to overseas communities.

Please be as candid as possible in your appraisal of the applicant’s suitability for this program. Indicate your assessment in the space below, using the reverse side for additional comments as needed, or you may attach a separate prepared page.

Please return this form to the student in a sealed, signed envelope, or you may deliver it to Michael Clifthorne, Office of International Programs, The Evergreen State College, Library 2153, 2700 Evergreen Pkwy NW, Olympia, WA 98505. Thank you for your assistance with this recommendation.

  1. In what capacity and for how long have you known the applicant:
  1. Check one letter for each category below. Please use the following scale in your assessment:

A = top 10% B = top 30% C = top 70% D = bottom 30% E = botton 10% X = no opinion

Intellectually curious / ☐A ☐B ☐C ☐D ☐E ☐X / Comments
Emotionally mature / ☐A ☐B ☐C ☐D ☐E ☐X / Comments
Independent worker / ☐A ☐B ☐C ☐D ☐E ☐X / Comments
Self-reliant / ☐A ☐B ☐C ☐D ☐E ☐X / Comments
Self-assured / ☐A ☐B ☐C ☐D ☐E ☐X / Comments
Adaptable / ☐A ☐B ☐C ☐D ☐E ☐X / Comments
Cooperative / ☐A ☐B ☐C ☐D ☐E ☐X / Comments
Well-mannered / ☐A ☐B ☐C ☐D ☐E ☐X / Comments

Please check the appropriate box:

☐ I highly recommend the applicant

☐ I recommend the applicant

☐ I recommend the applicant with reservation:

☐ I do not recommend the applicant

Please add any additional comments here, or attach a separate sheet:

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SignatureDate

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Name (please print)Position or title

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Office addressPhone