Middlesex University Student Exchange Programme

Registration of Interest Form 2017/18 (Undergraduate)

IMPORTANT: Before you complete a Registration of Interest Form

1.  Please ensure that you seek the advice and approval of your programme leader* for your exchange study options.

2.  Your exchange is conditional on you providing a completed Learning Agreement before the start of your exchange with full details of the modules you would study during your exchange.

3.  With very few exceptions (e.g. Nursing), it may not be possible for students to study abroad on an exchange during their final year - Please refer to page 6 of the University Regulations for further information.

Once you have completed this form, scan and e-mail it to .

For more information about grants and application procedures, please visit our pages on unihub: http://unihub.mdx.ac.uk/your-study/student-exchange

Join us on facebook: https://www.facebook.com/mdxexchanges/

PERSONAL DATA:

Middlesex University Student ID: |M00______|

Forename(s): |______| Surname: |______|

Middlesex Email: || Personal Email: |______|

Mobile number: |______| Passport Nationality*: |______|

MIDDLESEX UNIVERSITY STUDIES:

School (e.g. Business, Health and Education): |______|

Degree Programme (e.g. BA Film): |______|

PLANNED OVERSEAS STUDIES:

Academic Year you will be on exchange: □ 2017/2018 □ 2018/2019

Term you plan to be abroad: □ Term 1 □ Term 2 □ Full Year

Year of Study during exchange: □ 2nd year of a 3-year programme □ 3rd year of a 4-year programme

Will your exchange be in the final year of your degree (see above mention)? □ Yes □ No

Have you participated in the Erasmus Exchange programme previously? □ Yes □ No

CHOICE OF HOST UNIVERSITY (e.g. University of Valencia, Spain):*

1st Choice of University: |______|

2nd Choice of University: |______|

3rd Choice of University: |______|

*Please make a minimum of two choices.

LANGUAGE

Would you prefer to study in English? □ Yes □ No

List the languages you can read and write fluently in: |______|

Would you be interested in joining our ‘tandem’ language scheme; learn a new language and help others learn yours? □ Yes □ No

Additional information

Personal statement
The value of your exchange study visit towards your degree (not more than 200 words)
Additional information
(Special needs, financial hardship, extra-curricular engagement, community involvement, volunteering, Student Union & Societies, etc.)

BUDDY UP

Would you like to take part in our Mentor Scheme and be assigned a Student Mentor who has been on exchange and can support you in your preparation? □ Yes □ No

Would you like to join the ‘Erasmus+ International Society’ with students from all over the world who may be able to advise you on many ‘go abroad’ aspects? □ Yes □ No

DISABILITY

Do you currently receive support from the University’s Disability Service? □ Yes □ No

More information at: http://unihub.mdx.ac.uk/your-support-services/disability-and-dyslexia/information-for-students

Are you happy for the Exchanges Team to contact the Disability Service? □ Yes □ No

To be completed by the student’s Programme Leader

SUPPORT OF REGISTRATION OF INTEREST

I confirm that the student has my support to study on exchange for the year and duration specified. I acknowledge that my approval is conditional on the student completing, before the start of their exchange, a Learning Agreement with full details of the modules.

Signature: |______|

Name: |______|

Date: |______|

______

*Registration of Interest forms without your Programme Leader’s signature cannot be accepted.

Where have you heard of the Middlesex Exchange Programme?

□ Programme Leader □ E-mail □ UniHub website □ facebook □ UniHub Announcement □ Go Abroad Week □ Friends □ Other, please specify |______|

*if you hold a Tier 4 visa, please contact the International Student Visa Advice Team and inform them about your exchange study plans

Student Exchanges Office, Middlesex University, Hendon Campus, The Burroughs, London NW4 4BT, UK

Phone: 44 (0)20 8411 5579 Email: