Hessen-Massachusetts Student Exchange

Program Application for Study in Hessen

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Personal Information
Currently registered at (Name of institution):

UMASS–

/ Year in School (fr, soph, jr, sr, grad):

Name: (Family Name, First Name, Middle Name)

, , / Sex:
Male
Female
Birthplace
City:
Country: / Citizenship: / Date of Birth:
/ /
Month / Day / Year
Mailing Address
Street and number:
City, Postal Code:
Country: / (valid until):
Phone:
Email:
Permanent Home Address
Street and number:
City, Postal code:
Country: / Phone:
Email:
Contact in case of Emergency
Name:
Street and number:
City, Postal code:
Country:
Relationship: / Phone:
Email:
Study In Hessen
List the Hessen Institutions at which you would like to study in order of priority:
1.
2.
3.

This application is for the

Winter Semester only of 20__ / 20__
Summer Semester only of 20__
Both Semesters of 20__ / 20__
IUSP Marburg of 20__

Academic Information

Number of Semesters studied prior to this Application
Hessen-Massachusetts Contact at your International Office (Name, Campus Address) / Email:
Academic Advisor (Name, Campus Address): / Email:
Major:
Minor:
Level: undergraduate graduate
German Language Proficiency
How many years did you study German in High School?
How many years have you studied German at University level?
Highest German class taken before going abroad?
Have you visited Germany previously? For which purpose? (e.g. family, travel, school exchange, study, language course, etc.)

PLEASE ATTACH THE FOLLOWING WITH THIS APPLICATION:

¨ A COPY OF YOUR MOST RECENT UNIVERSITY TRANSCRIPT

¨ STUDENT STATEMENT (Reasons for applying to the exchange)- USE FORM ON NEXT PAGE

¨ STUDENT RESUME OR CV

¨ LETTER OF RECOMMENDATION / REFERENCE

Hessen-Massachusetts Student Exchange

NAME: DATE:

HOME CAMPUS: UMASS–

(NOTE: This section must be typed!)

Statement of Purpose

Briefly state your reasons why you wish to study abroad: