INBOUND Exchange Student APPLICATION FORM
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1 Place here recent 2x2 photo (with color) INBOUND Exchange Student APPLICATION FORM I. Period of Student Exchange at De La Salle University Term 1 (August December), Academic Year Term 2 (January April), Academic Year Term 3 (May August), Academic Year Name of home university Degree or Program of study Complete address of home university HOME UNIVERSITY INFORMATION II. Documents to be attached 1. Official Transcript of Records 2. Photocopy of passport bio-page and all pages with stamps 3. Letter of Endorsement from Home University 4. Photocopy of current courses/subjects enrolled in home university 5. Curriculum Vitae 6. Study Plan (list of courses to be taken at De La Salle University) III. Personal Information Last/Family Name: First/Given Name: Middle Name: of Birth (mm/dd/yy): Citizenship: Mailing Address: Address: Nickname: Title: Dr. Mr. Ms. Other: Gender: Female Male Place of Birth: Civil Status: Single Married Other: 1
2 Passport Number: Tel. No: Passport Validity (mm/dd/yyyy): Mobile No: In Case of Emergency Travel/Health Insurance: Company name: Person to contact: Relationship with student: Mailing address: address: Home tel. no.: Office no.: Mobile no.: IV. Extra-Curricular Involvements Organization Position Major accomplishments V. Language Proficiency Please check appropriate boxes and provide additional information: Degree of proficiency Excellent Average Poor I can speak English Others: I can write... English Others: I can read English Others: 2
3 VI. Work Experience Period Company/Location Position VII. Courses intended to be taken at De La Salle University a) Please refer to the attached *list of available courses per study field (*shall be forwarded to the International Office of home university once available.) For reference, the list of academic programs and courses with descriptions under the three (3) study fields can be viewed at these links: For Business - For Economics - codes.asp#soe For Engineering - b) The intended courses to be taken should be offered during the specific term of enrollment and will be approved by the hosting DLSU College/School. Availability of courses also depends on quota based on class size. c) DLSU allows a minimum of 12 units (4 courses/subjects) to a maximum of 18 units (6 courses/subjects) to be enrolled per term. d) Together with the Letter of Acceptance, DLSU shall provide the student with the list of approved courses that can be enrolled at DLSU. Please complete the table below: Title of course Course Code Credits
4 For DLSU USE ONLY: Remarks: Approved by: Signature over printed name Designation: : VIII. Parent s Certification of Permission This is to certify that I am allowing my son/daughter to join the DLSU AIMS Programme as a Student Exchange to be held from to at De La Salle University, (duration of the DLSU AIMS Programme) Philippines. It is understood that he/she will abide by the terms stipulated in the Memorandum of Agreement between De La Salle University and,. (name of home university) (country) I fully agree to waive any responsibility on the part of De La Salle University and (name of home university) in case of any untoward incident that may happen to my son/ daughter during the duration of the program. Signature over printed name of student Signature over printed name of parent/guardian IX. Declaration I declare that the information I supplied in this DLSU AIMS PROGRAMME INBOUND APPLICATION FORM are all correct and complete. I understand that the University has the prerogative to deny my application and impose penalties for incorrect or incomplete information I have deliberately supplied. 4
5 I recognize that it is my responsibility to provide all documentary evidence requested in this application. I authorize the University to obtain further information where deemed necessary. I agree to comply with University rules governing admission and enrollment of foreign students and with the policies on student exchange program. Finally, I understand that I am responsible for the prompt payment of any related fees as required in the program I am applying for. Signature over printed name of Student Witnessed by: Signature over printed name of Faculty Coordinator (or Faculty in-charge) of the Home University X. DLSU Contact Person MS. RHODOR B. CABALLERO Communications Specialist and IS Advisor AIMS Coordinator External Relations and Internationalization Office De La Salle University #2401 Taft Avenue, Malate Manila 0922, Philippines Telephone number: Trunk line: Ext rhodora.caballero@dlsu.edu.ph / erio@dlsu.edu.ph Website: Webpage: 5
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