EXCHANGE PROGRAMME

Application Form – Outgoing UCA Students

I am applying for: / Erasmus study
International study programme (NOT Erasmus)

PERSONAL DETAILS

Family name:
Forename(s):
Gender:
Date of birth:
Nationality:
Are you in the UK on a Tier 4 visa? / No Yes
Disabilities / Learning supportneeds: / None Yes- please specify:
Address:
Telephone:
Email:
Emergency contact name and telephone number:

STUDY DETAILS

Current UCA course:
Stage & level of study (eg BA, year 2 of 3):
Course Leader:
UCA student number:
Campus: / Epsom Canterbury Farnham Rochester

STUDY PLACEMENT PREFERENCES

Preferred host institution:
Name of course at preferred host institution:
Country:
Reserve host institution:
Name of course at reserve host institution:
Country:
Assistance needed in finding accommodation: / Yes No
(Please note that not all host institutions offer this service)

LANGUAGE ABILITY

First language:
Additional language:
Qualification gained (e.g. GCSE, A Level) and date:
Current level (basic / intermediate / advanced):
Additional language:
Qualification gained (e.g. GCSE, A Level) and date:
Current level (basic / intermediate / advanced):

IMPORTANT! Exchange students must fulfil the following criteria:

  • No units can be trailed into semester four.
  • All semester three units must be passed.
  • A minimum grade average of 55% is required.
  • A minimum of 135 credits must be passed at first attempt during semester one to three.
  • Basic language skills are recommended.

I accept that my Course Leader/International Mobility Co-ordinator/Associate Dean has the right to withdraw their approval for this Exchange at any time before it is due to take place, if they feel that this is in my best interest. I am aware that the grades earned during the exchange programme will only be assessed as Pass or Fail and therefore it will not count towards the final classification of my degree.

Signature of Student:
Date:

I confirm that this application is complete and approved, that a letter of motivation has been presented and that research on the partner institution(s) has been presented and is accepted.

Signature of Course Leader:
Date:
Signature of Study Abroad Coordinator:
Date:

CHECKLIST – please send with your application:

A statement explaining why you are applying for an Exchange
A small portfolio of work (weblink or pdf no larger than 3Mb)
Scanned copy of your passport photo page
Partner institution application form (preferred and reserve option)

PLEASE NOTE THAT YOUR APPLICATION WILL NOT BE ACCEPTED OR SENT TO YOUR HOST INSTITUTION UNTIL ALL THE ABOVE ITEMS HAVE BEEN RECEIVED AND ALL RELEVANT SECTIONS HAVE BEEN SIGNED.

Please return this form to: .

Forms must be received by the following deadlines:

27 June 2014

Film Production students: 14 February 2014

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