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NOTICE OF INTENT FORM

Choose One: ______JTA Fall ______JTA Spring ______STA

AdMU Schoolyear:______

  1. Personal Information (Please type or print in ink.)

NAME: (as it appears on your passport)

SURNAME FIRST NAME MIDDLE NAME

______

Year and Course: ______

Current Address: ______

______

Cumulative QPI:______

Attach printout of copy of grades and cumulative QPI from AISIS duly signed by Home Department or Program secretary.

Scholar: ______YES______NO

If YES, signature from Office of Admission and Aid or University Athletics Office:

______

Permanent Address:______

______

City: ______Postal code: ______

Telephone No: ______Mobile No: ______

E-mail: ______Gender: ___ Male ___ Female

Date of Birth: (day/ month /year) ______

Place of Birth: ______Citizenship: ______

Passport No: ______Place of Issuance: ______

Date of Issuance: ______Expiration Date: ______

Person to contact in case of emergency: ______

Relationship: ______Contact number(s):______

Address: ______

E-mail: ______

  1. Notice of Intent

I am expressing my intention to apply for the Ateneo de Manila University Junior Term Abroad Program / Summer Term Abroad Program. I have understood the duties and responsibilities that I, as a student of Ateneo de Manila University, have to fulfill in pursuit of my intention to be part of this program. If I get accepted into the program, my study experience abroad can have a concrete and specific impact to the local Filipino community by ______

______

Name and Signature of Applicant Date

  1. Conforme

I have discussed with my son/daughter and understood the terms and conditions and his/her duties and responsibilities as s/he pursues the application for the Ateneo Junior Term Abroad / Summer Term Abroad Program. I hereby express my permission and support to my son/daughter’s intention to pursue his/her application and participation to the said program.

______

Signature of Parent / Guardian over Printed Name Date

  1. Intent Fee (non-refundable but deductible from the Confirmation Fee):

Php 2000.00

Please secure the intent fee form from the JTA coordinator and present it to the AdMU Cashier upon payment

Submit the PINK slip together with this form to the JTA coordinator.

( ) Paid on ______RECEIPT NO: ______

IMPORTANT:

*The JTA Confirmation Fee DOES NOT INCLUDE: International Student Exchange Program Fee (approx. equivalent to one full semester tuition fee in AdMU), comprehensive travel insurance, medical tests, visa fees, airfare and travel agency fee.

*Applicant must consistently meet the eligibility requirements of his/her School in the AdMU even after acceptance to the program and payment of confirmation fees

*Balance of the non-refundable confirmation fee to be paid after acceptance to the program: Php 8,000.00 for non-scholars & Php 3,000.00 for OAA & UAO scholars.

Notice of Intent FormPage 1