MiddlesexUniversityStudentExchange
RegistrationofInterestFormUG Students
IMPORTANT NOTICE: Before you complete a Registration of Interest Form:
- Ask your Programme Leader for advice on your exchange plans and how they can best fit into your programme.
- You will need them to sign this form to show that they are aware of your interest and give permission for you to go on exchange for the period determined.
- Once you have completed this form, scan and e-mail it to .
- Your exchange is then conditional on you providing a Learning Agreement showing full details of the modules you would like to undertake while on exchange.
- With very few exceptions (e.g. Nursing), it is not possible for students to go on a study exchange during their final year due to university regulations and degrees*.
*Please refer to page 6 of the University Regulations for further information.
For more information about grants and application procedures, please see our website at UniHub/Your employment/Student exchange.
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 Honours 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-yearprogramme□3rdyear of a 4-yearprogramme
Will your exchange be in the final year of your degree (see above mention)?□ Yes□ No
Have you done Erasmus Exchange before? □ Yes□ No
CHOICE OF HOST UNIVERSITY (e.g. University of Valencia, Spain):*
1stChoice 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 statementThe value of your exchange study visit towards your degree (not more than 300 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’ and exchange with students from all over the world who may be able to advise you onmany ‘go abroad’ aspects? □ Yes □ No
DISABILITY
Do you currently receive support from the University’s Disability Service? □ Yes□ No
More information at:
Are you happy for the Exchanges Team to discuss this with the Disability Service? □ Yes□ No
SUPPORT OF REGISTRATION OF INTEREST
I confirm that this student is eligible for a student exchange for the period specified. I acknowledge that my approval is conditional on the student completing a Learning Agreement showing full details of the modules they would like to undertake while on exchange at a later date.
Programme Leader
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 |______|
Student Exchanges Office, Middlesex University, Hendon Campus, The Burroughs, London NW4 4BT, UK
Phone: 44 (0)20 8411 5962 Email: