APPLICANT NAME:
UAA 2017-2018INTERNATIONAL ACADEMIC EXCHANGE
APPLICATION PART 1: APPLICANT INFORMATION
APPLICATION DEADLINE: 5:00 p.m., March 1st, 2017
Please type or print neatly.
Name: ______DOB: ______UAA ID#: ______
UAA E-mail: Home Phone:(____)______Cell:(____)______
Please Circle Expected Degree(s): AA, AAS, BA, BS Major(s) ______
Minor(s) ______GPA: ______Expected Date of Graduation: ______
I am a: U.S. Citizen Non-U.S. Citizen
I will will not be accompanied by dependent family members while living abroad.
Note about citizenship and dependents: International students are welcome to apply. It is the student’s responsibility to understand the visa eligibility requirement(s) as well as what is required to secure the proper visa(s) for the country or countries in question. Similarly, students of any nationality with dependents are responsible for determining whether the visa requirements permit dependents to reside abroad with them and whether there are restrictions on their activities.
Academic Advisor(s):
Name: ______Phone: (____)______E-mail: ______
Name: ______Phone: (____)______E-mail: ______
_____ (Initial)I have met with my Academic Advisor to discuss my exchange plans, the applicability of available courses to my program of study, and the impact of my exchange on my graduation.
exchange program choice
Please read either the “2017-18 UAA International Academic Exchange Application Instructions” or the “UAA Japan Exchange Programs 2017-18” document as applicablebefore completing this application. Please check the box below to indicate the exchange program for which you are applying. If applying for a second exchange program as a back-up, please rankyour choices.It is important that you be committed to both choices.
* PARTNER INSTITUTION 1st CHOICE 2nd CHOICE
X:\Forms - Form Ltrs - Signs\App - Intl Exchange Application 2017-18 - Part 1 Applicant Information.doc
APPLICANT NAME:
Deakin University (Australia)
La Trobe University(Australia)
Hokkaido University of Education (Japan)
Iwate University (Japan)
University of East Anglia (England) ** Closed ** ** Closed **
University of Stirling(Scotland)
north2northuniversity: ______
SEMESTER(S) OF EXCHANGE
UAA Term/Semester (check one): Academic Year 2017/18 Fall 2017 Spring2018
emergency contact(s)
Please provide youremergency contact information. Include any special notes (e.g., “does not speak English”).
______
Contact’s Name RelationshipLocationNotes
______
Home Phone Cell PhoneWork Phone Email Address
______
Contact’s Name RelationshipLocationNotes
______
Home Phone Cell PhoneWork Phone Email Address
code of conduct/criminal history
Please check the appropriate box(es) below and provide additional information if necessary.
I have never had a university code of conduct violation or disciplinary sanction.
I have never been convicted of a felony and I am not on probation or parole, and have no legal judgments pending against me on or off campus.
I have had a university code of conduct violation or disciplinary sanction and/or have been convicted of a felony, am on probation or parole, or have other legal judgments pending against me. Please attach a separate page explaining your situation and addressing the status of the complaint(s).
attestation and signature
I understand that the Selection Committee considers candidates in a holistic manner, taking into account not only academic achievement and preparedness, but also evidence of motivation, maturity, cross-cultural sensitivity, adaptability, a strong interest in the host culture (and language, if applicable), and other characteristics that the Selection Committee deems relevant for student success abroad. The student’s application form, essay answers, transcripts, references, and interview all contribute to the Committee’s knowledge of the student.
I swear that all information I am providing is true and correct. I authorize the Office of International & Intercultural Affairs (OIIA) to provide my application materials and transcripts to the Selection Committee. If I have earned credits from institutions that are not on my UAA transcript at the time of application, I will provide official records to OIIA.
I have calculated the overall cost of my education abroad experience and determined how I will cover my expenses. I have carefully read and noted the payment deadlines, and cancellation and refund policies, and am aware of UAA’s projected financial aid and scholarship disbursement dates (if applicable).
Applicant’s Printed Name: ______Date: ______
Signature: ______
Submit Via Email or In Person (During Business Hours) To:
Leslie Tuovinen, Education Abroad Coordinator,
Office of International & Intercultural Affairs, Rasmuson Hall, Suite 115
Phone:(907) 786-4135 * Fax:(907) 786-1060 * Email:
X:\Forms - Form Ltrs - Signs\App - Intl Exchange Application 2017-18 - Part 1 Applicant Information.doc