EXCHANGEAPP

INTERNATIONAL EXCHANGE STUDENT UNCG APPLICATION

Please type or print clearly. Application should be completed in full. Any omissions may result in delays. Please remember to include official university transcripts. Your failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw you admission, or dismiss you after enrollment.

1. Name: ____________________________________________________________________________________
....................................SURNAME.................................................FIRST................................................MIDDLE
AS IT APPEARS IN YOUR PASSPORT--For Spanish speakers Surname begins with Apellido Paterno!

2. Present address: (valid until month_______/ day_______/ year_______)

________________________________________________________________________________________________

_______________________________________________________________________________________________

________________________________________________________________________________________________

telephone (with city code) ____________________________________________________________________________

E-mail ___________________________________________________________________________________________

3. Permanent address:

________________________________________________________________________________________________

telephone (with city code) ____________________________________________________________________________

4. Sex:_____female ______male

5. Specify the country in which you have citizenship. If you have dual citizenship, clearly indicate which passport you
will be using to travel to your host country.

________________________________________________________________________________________________

6. Legal Permanent Resident of:___________________________________________________________________

7. Date of birth: month_____________________(PLEASE WRITE OUT MONTH) / day_______/ year_______

8. Place of birth: (city and country) ___________________________________________________________

9. Would a dependent accompany you during the exchange? yes______ no______

If yes, please indicate below name, date of birth and your relationship to dependent:

10. Person(s) to contact in case of emergency:

Name(s): ________________________________________________________________________________________________

Address: ________________________________________________________________________________________________

Telephone (include area code): _______________________________________________________________________________

______________________________ Relationship to you

11. Highest degree completed or in progress:

Major field:_______________________________________________________

Minor field:_______________________________________________________

Projected completion date: month_______/ day_______/ year_______

12. Colleges or Universities Attended (include dates of attendance):

(Official academic records for each of these institutions should accompany application.)

_______________________________________________________________________________________________

Dates of Attendance Degree

Name_____________________________________(from_/_to)_________________________

Subject_________________(date_completed)_

13. Principal field(s) or area of study during exchange: ________________________________________________

14. Indicate the academic level at which you are requesting an exchange (check one):

_________Undergraduate _______Graduate

15. Duration requested for exchange (check one):

__________two semesters __________one semester

__________will consider either one or two semester exchanges

Beginning date requested: Fall __________ Spring __________ Summer __________

16. For non-native speakers of English wishing to study at UNCG:

TOEFL score: ___________ (score should be enclosed)

If TOEFL score is not enclosed, please indicate date exam was/will be taken:

_______ month /_______day /_______year

17. Campus Safety Questions (required by university policy) Your "yes" answer to one or more of the following questions will not necessarily preclude your application. However, your failure to provide complete, accurate, and truthful information will be grounds to deny or withdraw your application, or dismiss you after enrollment. For the purpose of the following questions, "crime" or "criminal charge" refers to any crime other than a traffic-related misdemeanor or an infraction. You must, however, include alcohol or drug offenses whether or not they are traffic related.

a. Have you been convicted of a crime?

No _____ Yes _____

b. Have you otherwise accepted responsibility for the commission of a crime?

No _____ Yes _____

c. Do you have any criminal charges pending against you?

No _____ Yes _____

d . Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any school, college, or university?

No _____ Yes _____

e. Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any school, college, or university?

No _____ Yes _____

f. If you have ever served in the military, did you receive any type of discharge other than an honorable discharge

No _____ Yes _____ Currently serving _____   Never served ______

If you have answered "yes" to any of the questions above, please explain the circumstances on a separate sheet of paper.

You must promptly notify the International Programs Center in writing of any criminal charge, any disposition of a criminal charge, or any school, college, or university disciplinary action against you, or any type of military discharge other than honorable discharge that occurs at any time after you submit this application. Your failure to do so will be grounds to deny or withdraw your admission, or to dismiss you after enrollment.

________________________________________________                          _________________________
                       Signature                                                                                     Date
I understand my failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw my admission, or dismiss me after enrollment.

TO BE COMPLETED BY YOUR HOME UNIVERSITY COORDINATOR

I hereby certify that the student has our full support to participate in the University of North Carolina Greensboro Exchange Program.

__________________________ _________________________

Name of Home Coordinator (please print) Signature

__________________________ _________________________

Date Phone/E-mail

Coordinator's Comments:

PLEASE NOTE THAT ALL APPLICATION DOCUMENTS ARE TO BE SENT TO UNCG BY YOUR EXCHANGE COORDINATOR. STUDENTS SHOULD NOT SEND APPLICATIONS DIRECTLY TO UNCG.

Applications should be mailed by your exchange coordinator to:
International Programs Center
PO Box 26170
127 McIver Street
UNCGreensboro
NC 27402-6170
USA
Tel (336) 334-5404
FAX (336) 334-5406
The University of North Carolina and all of its constituent institutions are committed to equality of opportunity. There shall be no discrimination within the University against applications, students, or employees on the basis of color, race, religion, gender, age, disability, or national origin, consistent with provisions of applicable state and federal law.

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