GLENDON COLLEGE/YORK UNIVERSITY
Office of Student Services
2275 Bayview Avenue – Toronto, Ontario – M4N 3M6
Tel: (416) 487-6716 - Fax: (416) 487-6779
EXCHANGE PROGRAM
SUBMISSION OF APPLICATION - ACADEMIC YEAR 20__-20__
UAB, SPAIN – UDLAP, MEXICO – UCR, THE NETHERLANDS
PERSONAL INFORMATION
Last name: ______First name______
Date of Birth: ______Place of Birth: ______
Citizenship: ______
If you are not a Canadian citizen are you a permanent resident? YES ¨ NO ¨
Student Number: ______
E-mail Address(Yorku address only):
______
Current Home Address (valid until ______):
______
______
Telephone number: ______Cell number: ______
Permanent Home Address: (if different from above)
______
______
Permanent Telephone Number: ______
EXCHANGE PROGRAM INFORMATION
List of Universities (choose one):
¨ Universitat Autonoma de Barcelona, (UAB) Spain
¨ Universidad de la Las Americas Puebla, (UDLAP) Mexico
¨ University College Roosevelt, Middelburg, (UCR), the Netherlands
Principal Field of study during exchange: ______
Exchange Period: Academic year ¨ Fall ¨ Winter ¨
Have you applied to the Ontario-Rhônes-Alpes Program? YES ¨ NO ¨
Have you applied to the York International Program? YES ¨ NO ¨
If yes, please indicate the university you have selected as your first choice: ______
Did you pay your $100 fee to York International? YES ¨ NO ¨
CURRENT ACADEMIC INFORMATION
Campus: Glendon ¨ Keele ¨
Major: ______Minor: ______
Current year of study: 1st ¨ 2nd ¨ 3rd ¨ 4th ¨
Program of study B.A Honors ¨ International B.A. ¨ Bachelor of Education ¨
Overall G.P.A. ______*
Number of credits to date (including Fall term courses): ______
* A grade point average of 6.00 (B) is required to participate in the exchange program. Applications handed in January with a G.P.A lower than 5.50 (C) will not be accepted.
LANGUAGE ABILITY
Please circle which best describes your level in Spanish (UAB and UDLAP) or English (UCR)
READING excellent good fair poor
WRITING excellent good fair poor
SPEAKING excellent good fair poor
COMPREHENSION excellent good fair poor
If applicable, please describe your formal and informal training in Spanish (UAB or UDLAP) or English (UCR):
______
______
______
I authorize Glendon College to forward my application and the required attachments to:
¨ Universitat Autonoma de Barcelona, (UAB) Spain
¨ Universidad de la Las Americas Puebla, (UDLAP) Mexico
¨ University College Roosevelt, Middelburg, (UCR) the Netherlands
I agree to abide by the regulations and decisions of the host university. I attest that the above information is complete and accurate.
Signature: ______Date: ______
Protection of Privacy Personal information in connection with this application is collected under the authority of Freedom of Information and Protection of Privacy Act and the York University Act, 1965. - This information is used to process your application and decide on your eligibility for the Exchange program. If you have any questions about the collection of this information by York University, please contact: Information and Privacy Coordinator, York University, Ross N926, 4700 Keele St. Toronto, Ontario M3J 1P3. Tel. (416) 736-2100 x 20359.