STUDENT EXCHANGE PROGRAM

INTERNATIONAL EXCHANGE APPLICATION FORM

1. PERSONAL INFORMATION

Surname: ______Name: ______

Date of birth: __/__/____ Place of birth: ______Country: ______

Address: ______n°: ______cap: ______city: ______

tel.: ______E-mail:______

Address in Rome:______n°: ____ cap: ______

2. FAMILY INFORMATION – Name, Profession, tel. or e-mail

1. / Father:
2. / Mother:
3. / Person to contact in
case of emergency:

3. ACADEMIC INFORMATION:

University of origin: ______

City: ______Country: ______Faculty: ______

Year of undergraduate study:

4. EXCHANGE PERIOD

q Fall Term (oct – jan) q Spring Term (feb – jul) q Full year

5. MOBILITY LANGUAGE

Do you want to follow courses taught in:

q Italian (at least B1) q English (at least B1) q Both

6. LANGUAGE PROFICIENCY
LANGUAGE / Translates / Speaks / Writes
Italian
English
Are you interested in UER Italian intensive course: q Yes q No
7. SUBJETCS
Are you interested in courses taught in Italian:
q Yes, only courses in Italian q Yes, some courses in Italian
q No, only courses in English
Are you interested in Short Program “Negotiation in International Relations ― NeIR:
q Yes q No
Are you interested in:
q Entire NeIR Fall program q Entire NeIR Spring program q Only some modules
First term of exchange
1. 
2. 
3. 
4. 
5. 
6. 
Second term of exchange
1. 
2. 
3. 
4. 
5. 
6. 
8. REQUIRED DOCUMENTS

- Three B&N/colour passport size photographs.

- Student Exchange Program admission form.

- Letter from your university authorizing the exchange.

- Official academic transcripts, with all the courses you have completed at the college or university you currently attend.

- Curriculum vitae.

- Verification of your ability to speak and understand Italian.

- Photocopy of valid Passport or ID (student from UE).

- Current health certificate.

- A copy or summary of your health insurance plan and/or a copy of your health insurance card (including repatriation expenses).

- Photocopy of your VISA (if necessary).

Write and attach to the present application an auto-biographic essay including information of your education, interest, education goals, participation in clubs and students societies and show us why do you want spend a semester or more at UER

Date: / Signature:

3

Ufficio Relazioni Internazionali, Via degli Aldobrandeschi 190 - 00163 Roma (Italia) Tel. (+39) 06 66527809 Fax: (+39) 06 665271 www.unier.it