Asean-European Exchange in Engineering

Asean-European Exchange in Engineering

Student Application- FALL 2013

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photo

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Part 1: Personal Information

1. Family name______

2. Given name______

3. Gendero femaleo male

4. Date of birth (day,month,year) ______

5. Place of birth (city and country) ______

6. Citizenship______

7. Passport number______

8. Passport expiration date______

(day, month, year)

9. Residence during academic year

We need this information in order to contact you while at school.

______

Dates at this address (day, month, year)

From______To______

telephone ______

fax ______

email ______

10. Permanent residence (home)

______

Dates at this address (day, month, year)

From______To______

telephone ______

fax ______

email ______

Other fax number where you can be reached: ______

Other email at which you can be reached: ______

11. Emergency contact:

Name: ______

Relationship: ______

Phone number: ______

Email address: ______

Part 2: Current Program

12. Institution______

13. Academic major (field, specialty) ______

14. Academic advisor ______

15. Academic advisor contact information

Telephone: ______

Fax: ______

Email: ______

16. Present year of studies(Current level) ______

17. Expected date of completion (month, year) and degree to be obtained ______

Part 3: Skills

18.First language(s): (languages spoken at home, in which you can communicate fluently)

______

19. Other language(s):

Please assess yourself for each other language using the scale below.

language 1: ______

years of study _____

reading/writing ______

1 = fluent

2 = good communication / comprehension

3 = working knowledge

oral______

1 = fluent

2 = good communication / comprehension

3 = working knowledge

language 2: ______

years of study _____

reading/writing ______

1 = fluent

2 = good communication / comprehension

3 = working knowledge

oral______

1 = fluent

2 = good communication / comprehension

3 = working knowledge

20. Computer languages / 21.Sofware applications
(WordPerfect, MS Word, Excel, Lotus, etc.)
a- / a-
b- / b-
c- / c-
d- / d-

22. Other skills, interests, or hobbies:

______

Part 4: Practical Experience (engineering internship, co-op, etc.)

23. List most recent or most relevant position held.

Company name: ______

Dates employed:

from (day, month, year) ______to (day, month, year) ______

Please describe your position and duties/responsibilities.

______

Position title: ______

You may list additional experience in that comments section:

______

Part 5: Program Preferences

24. Country for which you are applying

______

25. Placement preferences

It’s compulsory to give us at least three choices, as your first (or second) choice could be rejected. There is no ranking, but the listed universities must all of them offer the courses that the applicant would need to attend. Please write correctly the whole name of the institutions.

26. Please give us the reasons for these choices in that comment section:

______

27. Program duration (check one).

___one semester of academic study

28. Are you planning to take (check one)

______all or mostly undergraduate courses

______all or mostly graduate courses

Earliest date by which you can leave your home country and begin your program abroad (day, month, year)

______

Latest date by which you must end your program abroad and return to your home country (day, month, year)

______

29. Which type of housing arrangements do you prefer? (rank 1 to 4 in order of preference) Please note that not all types of housing may be available at all locations.

a. _____ on campus with a student from the host country

b. _____ off campus with a family (home stay)

c. _____ on campus in a single room

d. _____ off campus (apartment)

29a. Do you smoke? ______

29b. Are you willing to share accommodation with a person who smoke? ____

Part 6: information

The student is asked by GE4 if he/she agrees to provide this information to other parties different from the universities requested.

Signature of the applicant

Asean-European Exchange in Engineering

Student Application- FALL 2013

PROGRAM OF STUDIES FORM (1st page)

Student Name______

FamilyGivenMiddle

Home Institution______

Name of the academic advisor (international coordinator at your School at the UVigo):

______

Please, list courses offered at your home institution for which you would like to find corresponding courses at your host institution overseas. Please indicate if the course is necessary for your participation in the program (if you will not accept placement at an institution which does not offer an equivalent course). Please attach a course syllabus for each course listed below.

To be completed by host institution only:

Host Institution______

Note to host institution: Please attach descriptions for each course listed in the shaded area above before forwarding to the student’s home university.

To be completed by the student only:
Desired courses / Is the course necessary for participation in the program? / To be completed by host institution only:
Suggested corresponding course at host institution (name and number)
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______/ Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No / 1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______

Asean-European Exchange in Engineering

Student Application- FALL 2013

PROGRAM OF STUDIES FORM (2ND page)

Student name ______

Please describe any additional courses which you would like to take overseas but are not normally offered at your home institution.

______

To be completed by host institution only:

Suggested courses at host institution which match those described above / Other courses required at the host institution by the home institution:
1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______/ 1. ______
2. ______
3. ______
4. ______
5. ______
6. ______
7. ______

Signatures and stamps:

Name and signature of
international coordinator at Uvigo
UNIVERSIDADE DE VIGO / Name and signature of student advisor
or ASE3 representative
Host University