PROGRAMS FOR STUDY ABROAD

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1 PROGRAMS FOR STUDY ABROAD International Undergraduate and Graduate Exchange Student Application Instructions PLEASE SUBMIT THE FOLLOWING: (DO NOT STAPLE ANY DOCUMENTS TOGETHER!) Completed application. Official or certified university transcript showing all university courses taken in the past with grades; include a list of courses in which you are currently enrolled. If transcript is not in English, it must be accompanied by a certified translation. Photocopy of your passport identification pages (those with your full legal name). Original financial documents from a bank or broker verifying financial support of USD $7,185 for the Fall 2015 semester or $14,370 for the academic year. Photocopies or certified copies will not be accepted! U.S. government stipulates original documents only! Letter from your university verifying your English language ability or a certified copy of your TOEFL or IELTS score report. Please note that this is required only if English is not your native language or if the language of instruction at your home university is not English. Please DO NOT submit any of the following: résumés personal statements/essays letters of recommendation your home university s study abroad application APPLICATION DEADLINES Spring Semester/Calendar Year Applicants: October 1 Fall Semester/Academic Year Applicants: March 15 NOTE: Students pursuing undergraduate Management, Computer Science, or Technology programs are encouraged to apply early for greater consideration of their application. Remove this page, then return completed application to: Programs for Study Abroad Purdue University Young Hall, Room Wood Street West Lafayette, IN USA tel Revised:2/14/12

2 AFFIX PHOTO PROGRAMS FOR STUDY ABROAD HERE International Undergraduate and Graduate Exchange Student Application & Notification of Intent Home university: Period of exchange at Purdue: fall semester 201 spring semester 201 (check one only) academic year 201 /1 calendar year (spring & fall) 201 PERSONAL DATA (please type or print clearly in black ink) Full legal name (as it appears in passport): Family Name First Middle Gender: Male Female Date of birth: Place of birth: Month / Day / Year City Country Do you have a U.S. passport? Yes No U.S. Social Security Number (if none, leave blank): Country of citizenship: Country of legal permanent residence: (if dual citizenship, list only country of passport you will use to travel to U.S.) What is your present position in your home country? undergraduate student graduate student Permanent home address: Street Address City Postal Code Country Telephone Address Parents/Guardians: Name(s) Relationship to you 1

3 FINANCIAL CERTIFICATION Purdue University requires evidence of financial resources for room, board, and personal expenses, etc., for each nonimmigrant student. The student s financial sponsor must sign the statement below and provide supporting documentation from his/her banker or broker as proof of financial means. We will not be able to issue the Form DS-2019 until we receive this information; the DS-2019 is needed to apply for a J-1 student visa at a U.S. consulate. Please provide evidence of: USD $7,185 for one semester (fall or spring only) USD $14,370 for one year (two consecutive semesters) Financial sponsor's full name (please print clearly): Family Name First Middle This is to certify that I will be the financial sponsor of (student s name) will assume full financial responsibility for these finances while s/he attends Purdue University. and Sponsor's signature: Relationship to student: Sponsor's complete address: ACADEMIC DATA Field of study at Purdue: College (example: Engineering) Department (example: Mechanical Engineering) English proficiency (check one): English is my native language or the language of instruction at my home university. I am enclosing a copy of my TOEFL score report (for minimum requirements, see the following web page I am enclosing a letter from my home university attesting to my English language skills. PERSONAL CONDUCT Purdue University recognizes that an educational environment characterized by safety, respect, honesty, and integrity enhances learning for all students. All applicants are required to respond fully to the questions below. Information will be reviewed and in some serious circumstances may result in denial of admission. 1. Have you ever been disciplined (e.g., placed on probation, suspended, or expelled) by any secondary school, college, or university you have attended? Yes No If yes, please explain (attach a separate sheet if necessary): 2. Have you ever pleaded guilty or no contest, participated in a pre-sentencing diversion program and/or been convicted of a criminal offense (including in a juvenile court), or are there criminal charges pending against you at this time? Yes No If yes, please explain (attach a separate sheet if necessary): 2

4 STUDENT CERTIFICATION/SIGNATURE I affirm, under penalties for perjury, that the representations on this application, including information related to my citizenship status and/or presence in the United States, are true and accurate. I understand I will be responsible for all necessary educational expenses not specifically covered by the terms of the Exchange Agreement between Purdue University and my home university. Upon arrival at Purdue, I also understand that I must either purchase Purdue s health insurance or submit Purdue s insurance waiver form with supporting documentation (in English) that verifies my accident and health insurance coverage. I hereby authorize Programs for Study Abroad to request my Purdue transcripts from the Office of the Registrar upon completion of my exchange program. Signature of Student Date Application forms not completed in full, dated, and signed will not be considered. Return this application along with supporting materials to your home university s exchange program coordinator. HOME UNIVERSITY APPROVAL (Name of student) of our bilateral student exchange agreement. is nominated to study at Purdue University according to the terms Name of Exchange Program Coordinator Signature Date Title University Name Address Street Address City Postal Code Country Telephone Number Fax number 3

5 PURDUE UNIVERSITY EXCHANGE STUDENT COURSE REGISTRATION FORM Name: Family Name First Home university: Name Location Field of study at home university: Category of exchange (check one only): undergraduate student graduate student (possible only if Purdue and the home university have agreed to exchange graduate students) Period of exchange at Purdue (check one only): fall semester 201 academic year 201 /1 spring semester 201 calendar year (spring & fall) 201 To assist us in processing your application and ensure you are admitted to the correct academic department, please list the courses that you would like to take at Purdue as well as some alternate courses in case your first choices are not available. For instructions on how to research course options and to access Purdue s schedule of classes, please visit If courses for your term abroad are not available yet, please choose classes based upon past offerings. The minimum course load for undergraduate students is 12 credits per semester (usually about 4 courses), although undergraduate students generally take anywhere from credits per semester. Graduate students should register for 9 to 15 credits per semester. For students spending a year at Purdue, this registration form serves to enroll you in classes for your first semester only. NOTE: Some 500- and all 600-level courses are graduate courses and are not available to students on undergraduate exchange programs. When prerequisites have been met they are open to graduate students. Subject Abbreviation / Number / Title (ex: BCHM 100 Intro to Biochemistry) Alternate Courses

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