APPENDIX 1: n2n STUDENT APPLICATION FORM

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Carmel Neal
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1 University of the Arctic north2north Student Mobility Program Application deadline for every academic year is February 15. Section A: Personal Data Home Country: Sweden Home institution: Umeå University Family Name of applicant: Ditt efternamn First Name of applicant: Ditt förnamn Gender: Female Male ringa in! Date of Birth (dd/mm/yy): Current Address: Din adress Telephone: Bank Information and SWIFT code: Permanent address, telephone, (if different from above): Telefonnummer E-postadress Swift-kod fås från din bank. Hemadress (om den inte är densamma som adressen ovan) Are you a citizen or permanent resident of the country in which you currently reside? ringa in! If no what citizenship: Emergency contact name: Relationship: Address: Telephone: Ange medborgarskap om ej svenskt. Namn på närmast anhörig Relation till närmast anhörig (förälder, syskon etc.) Adress till närmast anhörig Telefonnummer till närmast anhörig E-postadress till närmast anhörig Section B: Application Information Do you apply for north2north scholarship (Ansöker du om stipendium?) If not allocated a scholarship, are you still interested (Vill du fortfarande ha en plats även om du inte får stipendium?) 1

2 Do you apply for tuition waiver: 1 (Available at most UArctic North-American Institutions and some Icelandic) (Vill du ansöka om att inte behöva betalas terminsavgift?) If not allocated a waiver are you still interested? (Vill du ha en plats även om du måste betala terminsavgift?) If offered are you interested in paying a domestic fee? (Kan du tänka dig att åka om du måste betala så kallad domestic fee ungefär som terminsavgiften fast något lägre)? 1 Students offered a tuition waiver do not have to pay tuition fee at host institutions claiming tuitions. 2

3 Section C: Academic Information Your degree program/ major subject: Year of Study before the exchange: Intended year of graduation: Name of north2north contact person at home institution: Ange ditt program/de kurser du läser vid Umeå universitet Antal år du studerat hittills Ange det år du planerar att ta examen Helena Gradin Section D: Host Higher Education Institution and Program Preferences Indicate your desired exchange institution and program preferences and be as exact as possible according to name of courses and eventually course codes. Please rank your first three choices according to preference: 1. Name of Host Institution: Val av N2N-universitet Name of Host Institution: Val av N2N-universitet 2. 1). 2). 3. Name of Host Institution: Val av N2N-universitet 3. 3). 3

4 Proposed dates of study: From (dd/mm/yy): To (dd/mm/yy): Section E: Languages Primary Language: Other Languages: (Ange andra språk du behärskar.) Ange ditt mordersmål Have you taken an English proficiency test (TOEFL, Cambridge language proficiency, etc.): If yes, please indicate type and result: Datum för terminsstart Datum när terminen avslutas Competence, on a scale of 1 to 4 (1 = basic, 4 = fluent) No Type: Exam Result:... Section F: Indigenous or Non-traditional student category Answering this question is optional. Are you an indigenous student? (Indigenous people includes first nation people and aboriginals till exempel samerna) Do you fit into a non-traditional student category? ( Non-traditional in this context is if you are living in a remote or very small community, are older than the average student, are a student with family obligations etc.) If Yes for fitting into a non-traditional student category, please describe how: Section G: UArctic Program Student Is the exchange part of a thematic network activity? Are you a UArctic Graduate or Under graduate student? Section H: Application submission Complete this form and return it with the required documents (Letter of Intent, references, Academic records, Curriculum vitae) to the Institutional n2n Administrative Contact Person of your home institution (see It is the responsibility of the student to ensure that all materials are submitted. Please read and sign: I acknowledge that all statements on this application form and supporting documents are complete and accurate to the best of my knowledge and ability. I commit myself to make use 4

5 of Learning Agreement and after the exchange to fill out the Students Post-Exchange Feedback Form and hand in to my home institution. The form is available on the UArctic north2north webpage. Skriv under Applicant s signature Ange datum Date 5

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