Outgoing Exchange Application Approval Form

Outgoing Exchange Application Approval form

Application process

to complete this form please:

1)  Make an appointment with a Academic Programme Advisor

2)  Make an appointment with your Course Leader/Institute Exchange Coordinator (as appropriate)

Current Institute exchange coordinators:

Dr Robin Bell – Worcester Business School

Dr Andreas Mueller – Institute of Humanities and Creative Arts

Dr Geoff Kohe – Institute of Sport and Exercise Science

Dr Tory Milner – Institute of Science and the Environment

Dr Gareth Dart – Institute of Education

3)  Return the completed form together with: An Academic Reference and Personal Statement

to: Lois Lewis, Exchange Coordinator, Student Services, before the end of March.

Proposed exchange dates:

Academic year: 20___/20___ Semester 1 (Sept – Dec) * Semester 2 (Jan – May) *

(Some partner institution semester dates may vary slightly)

(PLEASE PRINT CLEARLY)

OUTLINE OF YEAR 2 MODULES

Signatures of approval are required from your academic tutor(s) (one for Single Hons and one from each subject if Joint Hons) , and a Programme Advisor.

They will look at your programme of modules for year 2 and acceptable substitutes for the exchange period, also the assessment arrangements for January, if you are going on exchange in semester 2.

Year 2

Modules that would normally be taken at UW if not on exchange:

Semester 1

Semester 2

Student intending to go on exchange in: Semester 1 Semester 2

Module to be replaced
(UK credits) / Semester / Substitute module / Semester / Institution

Above programme approved by

Academic Tutors

______Course Leader Dated______

______Second Course Leader Dated______

Programme Advisers (after replacement module programme has been approved by academic tutors):

______Programme Advisor Dated______

EXCHANGE PROGRAMME

REFERENCE REQUEST FORM

Student Name______Student Number______

Name of Referee______Department______

REFEREE: After an interview with the above student could you please complete the form below and return it to Lois Lewis (Peirson Centre).

The above student wishes to submit an exchange application to study abroad for one semester. The programme is under the supervision of a representative of an exchange partner university. Such study places unusual demands on the student, requiring a greater degree of adaptability and of concentration than is usually the case on campus.

Please rank the applicant on the following traits by checking the appropriate box:

(5=excellent; 4-above average; 3=good; 2=below average; 1=poor; X=unknown or not applicable)

5 / 4 / 3 / 2 / 1 / X
Academic Ability
Adaptability
Ability to articulate
Ability to get along with others
Emotional maturity
Foreign language ability (if applicable)
Intellectual curiosity
Persistence
Self-reliance
Sensitivity to others

Please indicate your opinion of this individual and his/her chances for success. Keep in mind that studying and living abroad places new and different demands on students. Please express any reservations you have in advising this student to study abroad where adaptability, tolerance, self reliance, persistence, sensitivity, emotional maturity, and academic ability will be very important.

Signed______please also print name______

We would remind you that the Data Protection Act gives an applicant the right to ask for a copy of the reference and any other personal information that we hold about them.