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Student Exchange Application Form

This document is an application form for an international collaboration program in 2019. It requests the applicant's personal information such as name, gender, date of birth, passport number, nationality, email, home and mobile phone numbers. It also asks for academic information including country, university currently attending, year of study, and major. There are sections for brief descriptions of personality, interests, hobbies, medication, diet, and anything else the program organizers should know. Finally, the form requests consent to share administration information with the university and retention of personal information from the program start date to graduation.

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Dhimăs
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23 views3 pages

Student Exchange Application Form

This document is an application form for an international collaboration program in 2019. It requests the applicant's personal information such as name, gender, date of birth, passport number, nationality, email, home and mobile phone numbers. It also asks for academic information including country, university currently attending, year of study, and major. There are sections for brief descriptions of personality, interests, hobbies, medication, diet, and anything else the program organizers should know. Finally, the form requests consent to share administration information with the university and retention of personal information from the program start date to graduation.

Uploaded by

Dhimăs
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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International Collaboration Program 2019

Application Form

Name
* Please write your name according to your passport, only in English

Gender Male / Female

Date of Birth ___________ ___________ ___________


(Month) (Day) (Year)

Passport
Number

Nationality

Email

Permanent
Address

Telephone Telephone
Number Number
(Home) (Mobile)

ACADEMIC INFORMATION

(Country)
University you are
currently attending (University)

Present Year of
study

Major(s)
Please tell us about your personal information that we should know before you come.

1) Please briefly describe your personality, interest and/or hobbies (no more than 150
characters)

2) Medication (Please inform us if you are taking any medication, no more than 100
characters words)

3) Diet (Select your diet, if required)


Hala ( ) Vegan ( ) Pollo (no meat, seafood ok) ( ) etc.

4) Is there anything else that you would like us to know? (no more than 50 characters)
Consent for Sharing of administration information
※ I certify that all the information provided in this application is complete and accurate to
the best of my knowledge. I hereby apply to the program and agree to comply with the
rules and regulations of Y’sU (Youngsan University) if admitted.

Personal Information Third-party provision agreement

1. Person who receives personal information: University of information subject


2. Personal information of the person who receives personal information
3. Purpose of use: Filed trip participation of information subjects
4. Personal information items collected: Name, student No., Birth date, affiliations, gender,
nationality, phone No., transcript
5. Personal information retention and period of usage: from the date of start to graduation
6. The information subject has the right to refuse to accept the offer. However, in such
cases, it may be impossible to transfer credit to the university of the information subject.

( ) Agree ( ) Do not agree

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