Exchange Student Application Fall 2016 Spring 2017

Transcription

1 Exchange Student Application Fall 2016 Spring 2017 Application deadlines One-year exchange program: March 1, 2016 (program begins August 2016) Fall (August-December) Semester only: March 1, 2016 Spring (January-May) Semester only: October 1, 2016 CHECKLIST REQUIRED APPLICATION MATERIALS Exchange Program Application Personal Essay (see instructions below) One (1) passport-size photo Original university transcript Copy of passport identification page Original bank statement TOEFL score report (minimum required score: 563 PBT, 223 CBT, 85 IBT with at least at 20 in each Writing, Reading, Speaking & Listening) or IELTS score report (minimum required score: 6.5) Mail completed application to: Admission Office c/o Loutfi Jirari, Director of International Recruitment P.O. BOX 37. Greencastle, Indiana USA PERSONAL INFORMATION Full legal name: Prefer to be called Home address: Family name Given name Middle, if any

2 Mailing address, if different from above: Home telephone: + Fax number: + (if available) Personal (permanent) address: School-issued address (if applicable): Sex: Female / Male Date of birth: Place of birth: month / day / year City Country Country (countries) of citizenship: All language(s) spoken: 1. Circle option that best describes your fluency level in this Language language): Fluent Advanced Intermediate Beginner 2. Circle option that best describes your fluency level in this Language language): Fluent Advanced Intermediate Beginner 3. Circle option that best describes your fluency level in this Language language): Fluent Advanced Intermediate Beginner Travel experiences (location and length of trip): EDUCATIONAL INFORMATION Most recent university attended: Dates attended: Other universities or special programs attended, with dates: Major field(s) of study at home university: Minor(s): Possible career goal(s): Courses you intend to take at DePauw (refer to the Schedule of Classes 2 P a g e

3 Department Course Number Title Instructor Required for major/degree? If you are a degree-seeking student (Kansai Gaidai University, only), which of the majors offered at DePauw do you intend to declare: Please review the list of available majors here: Official TOEFL score and date taken (if applicable): Section Score (applicants must have a score of at least 20 for each section) Speaking Listening Reading Writing (Note: Only test results issued within the last two years will be accepted for this application process.) IELTS score and date taken (if applicable): (Note: Only test results issued within the last two years will be accepted for this application process.) FAMILY CONTACT INFORMATION Mother/Guardian Family name Given name Middle, if any address: Home telephone number: Home address, if different from yours: Occupation: Work telephone number: Father/ Guardian Prefers to be addressed as (Dr., Hon., Mr., Rev., Other) Family name Given name Middle, if any address: Home telephone number: 3 P a g e

4 Home address, if different from yours: Occupation: Work telephone number: EXTRACURRICULAR INFORMATION Activities: Honors and prizes: Athletic involvement: Volunteer and service experience: Employment experience: Religion/Faith practices: (optional) HOUSING PREFERENCES: Floor-type preferences: Single gender Coed (mixed genders) I prefer the following living arrangements: Traditional Upper Class Housing (with meal plan) Reese Hall (suite-style living with upper class students, single room, and partial meal plan University owned apartment or house (single or shared rooms with upper class students, no meal plan required) Please indicate your room preference: Single Double Triple Do you smoke? Yes No Do you object to having a roommate who smokes? Yes No 4 P a g e

5 PERSONAL ESSAY INSTRUCTIONS This personal statement helps us become acquainted with you in ways different from courses, grades, test scores, and other objective data. The essay will demonstrate your ability to organize thoughts, express yourself and understand why you have chosen to apply for exchange at DePauw University. We are looking for an essay that will help us get to know you better as a person and as a student. Please write and type an essay ( words) on the following topic and include it with your completed application materials: Please describe your goals, how you formed them, and how studying abroad at DePauw University can help you achieve your goals. SIGNATURE My signature certifies that, to the best of my knowledge, the information I have provided on this application and in supporting documentation is accurate and complete. I understand that these application materials are confidential and will not be released to me or to any other person, except as provided by law. Applicant s signature: Exchange Partner Representative Signature: Date: Date: Exchange Partner Representative contact information Name: Mr. / Ms. Given name Middle name (if any) Family name Title: address: 5 P a g e

6 DePauw University Exchange Student Release of Information I authorize and request the appropriate officials at DePauw University to report my registration, courses, credits and grades to my Exchange Program Coordinator at my home institution each academic term as long as I am on an established exchange program through DePauw University and my home institution. These reports are to be addressed to the Exchange Program Coordinator: Name: Title: Office: University: Street Address: City: Country and Postal Code: Signature: Date: Printed Name (block letters): _ 6 P a g e