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Exchange Program Application Please note: This application is for University of Dayton students applying for a semester or year-long exchange with partner universities. Please visit the summer study abroad programs page if you are interested in the UD summer study abroad programs. Your application is not complete until you have submitted: A copy of your transcript Student Health Information Sheet Release Form Authorization Form Behavioral Contract Bursar's receipt for the $50 application fee If you have not already done so, please meet with the partnership and exchange coordinator to obtain these additional forms. General information Last name:     First name:     Middle name: E-mail: Date of birth: Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950     Gender: Male    Female    Are you a U.S. citizen? Yes    No Class status (2009-10): First-year    Sophomore    Junior    Senior    Graduate Student ID number:     Class of Select one 2008 2009 2010 2011 2012 2013 2014     GPA: Major:       Minor: On campus contact information Street address: City:     State   Ohio Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     Zip code: Telephone: Permanent contact information Street address: City:     State   Ohio Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming     Zip code: Telephone: Program details Indicate the program for which you are applying:   Al Akhawayn University Ecole Nationale Supérieure d'Ingénieurs de Bourges Ecole Supérieure de Commerce, de Management et        d'Entreprenariat (ESPEME) Ecole Supérieure des Sciences Commerciale d'Angers        (ESSCA) Helsinki School of Economics Institute Catholique de Paris Korea University Nanjing University National University of Ireland, Maynooth Radboud University Nijmegen Shanghai Normal University Universidad Marista de Mérida Universidad Pontificia Comillas Universitat Augsburg Université Catholique de l'Ouest Universidad de Deusto Villa Nazareth Which semester will you study abroad? (If studying abroad for a full year, select both semesters.) Spring 2010      Summer 2010      Fall 2010      Spring 2011 The application deadline for the spring term is October 1. The application deadline for the summer and fall terms is March 1. Financial information Will you be using financial aid? Yes    No Personal statement In the space below, please write a brief statement addressing why you would like to participate in the Exchange Program and what you hope to gain from an international experience. Applicant agreement I hereby authorize the release of information from my student academic and disciplinary records upon request to the Center for International Programs. I certify that the information on this application is correct. I understand that if selected to become a participant in the program, I shall be subject to all rules, regulations and requirements of the University of Dayton. I have read and understanding the policies related to standards of behavior, and I understand the consequences of not adhering to the standards of behavior. I also give the Center for International Programs permission to notify the Counseling Center and Student Learning Services of my application with the understanding that these two offices will not provide the Center for International Programs with any information unless I have given further permission beyond this statement. Your application is not complete without the $50 Bursar's receipt for the application fee! Please submit your Bursar's receipt for the non-refundable $50 application fee to: Center for International Programs Tina Manco, Partnerships and Exchanges Coordinator Alumni Hall 220 300 College Park Dayton, OH 45469-0315

Center for International Programs · University of Dayton · 300 College Park · Dayton, OH 45469-0315 Telephone: (937) 229-3514 Questions and comments: Webmaster