ACAP Student Exchange Abroad (Outbound) Application Form Eligibility Criteria: You are an ACAP student enrolled in an ACAP higher education course and have successfully completed a minimum of six units You have gained a minimum Credit grade average for all units attempted You hold a current passport valid for at least six months after your intended return date Please Note: If spaces for a partner institution exchange are limited, your academic merit, academic references and your personal statement will be assessed by ACAP to help determine nomination for the partner institution in a particular year Your study plan must be prepared in consultation with the ACAP Academic Advisor for your course and be finally approved by your Head of School prior to applying to an overseas partner institution to ensure overseas study successfully completed is comparable and can be recognised as credit towards your ACAP course Please follow the application submission steps as outlined in the Student Exchange Abroad (Outbound) Information Guide Please print in BLOCK LETTERS. Please read this form carefully and complete all relevant sections. Please keep a copy for your reference. 1. Personal details Title: Mr Ms Mrs Miss Dr Other Family name: Given names: Preferred name: Date of birth: / / (day/month/year) Citizenship: Country of permanent residence: Country of birth: Passport number: Sex: Male Female ACAP student ID number: 2. Contact details Home Address in Australia: Street: Suburb: Postcode:.... Home telephone: Mobile telephone: Personal Email: Accommodation Address overseas (if known): Street:..... Suburb:...Postcode:... Home telephone: Mobile telephone: Email: ACAP Student Exchange Abroad (Outbound) Application Form 2012 1 of 12
3. ACAP course details Course code, Name and Specialisation (if applicable): Academic School: Name of Academic Advisor: In which year and term did you commence this program? Indicate which year you are currently enrolled in: Year 1 Year 2 Year 3 Year 4 4. Host institution details Please indicate the name of institution (in full), term and year you intend to undertake studies: Name of partner institution in full Partner Institution Term/s and Year/s Number of Terms Proposed Start and End dates: Start Date:... End Date:... 5. Study Plan For discussion with and provisional approval by your ACAP Academic Advisor prior to submission of Application for final approval by Head of School Please indicate in the table below: A. The preferred unit/s you wish to study at the partner institution and the corresponding units in your enrolled ACAP course that you wish to obtain credit for upon your successful completion of the corresponding partner institution unit/s. It is your responsibility to ensure that your preferred program equates to a full-time study load at the partner institution. Please indicate your preferred payment method for each subject you are granted approval for. B. The alternate substitute units you wish to study at the partner institution in the event that any of your preferred units are not available at the partner institution in the term in which you wish to study. Partner (host institution) Unit/subject code and name A) Preferred Program 1. Corresponding ACAP (Home institution) Unit code and name equivalency/preferred payment method Payment Method: Fee-Help...% Upfront Fees... % (Internal Office Use Only) Academic Advisor to HoS to counter-initial as final approver Approved Not approved 2. 3. 4. Payment Method: Fee-Help...% Upfront Fees... % Payment Method: Fee-Help...% Upfront Fees... % Payment Method: Fee-Help...% Upfront Fees... % Approved Not approved Approved Not approved Approved Not approved ACAP Student Exchange Abroad (Outbound) Application Form 2012 2 of 12
B) Alternate substitute units/subjects 5. Payment Method: Fee-Help...% Upfront Fees... % Approved Not approved 6. Payment Method: Fee-Help...% Upfront Fees... % Approved Not approved (Internal Office Use Only) Applicant must arrange for this section to be completed and signed by ACAP Academic Advisor BEFORE completing all other requirements of this application STEP 1: Approval of Study Plan by Academic Advisor in your discipline (Provisional approval pending sighting of Academic References/Academic Transcript/Statement of Purpose) Signature:...... STEP 2: Recommendation for Approval of Application by Academic Advisor (Recommendation for approval requires sighting and review of completed ACAP application including Academic References/Academic Transcript/Statement of Purpose together with completed partner institution application) Date: Signature:... Date:... To be completed by ACAP Head of School following review/assessment of fully completed application submission by Academic Advisor STEP 3: Final Approval of Application and Study Plan by Head of School Signature:.. Date:... Letter of Nomination/Approval for exchange with partner institution attached and signed by HoS Reasons for subjects and/or application not approved 6. ACAP Tuition Fees If your application is successful, ACAP will enrol you into your approved ACAP corresponding units as you commence your exchange. At that time, you will be liable to ACAP for the tuition fee of the ACAP unit/s that corresponds with the units you attempt at the partner institution, as stated in your approved ACAP Study Plan. At the commencement of your exchange you will also need to advise ACAP of your preferred payment method * for your enrolled ACAP units via ACAP s online enrolment portal. * ACAP students participating in the ACAP Student Exchange Abroad (Outbound) program who are Australian citizens or permanent residents with a Humanitarian Visa can defer all or a portion of their ACAP tuition fees through the Australian Government s FEE-HELP scheme. ACAP students participating in the ACAP Abroad exchange program who are international students or Australian permanent residents without a Humanitarian visa or New Zealand citizens will be required to pay their ACAP tuition fees up-front to ACAP. For further details on ACAP s tuition fees and refund policies go to: http://www.acap.edu.au/costs.html 7. Medical/disability Do you have a disability, impairment or long-term medical condition which may affect your studies that you have not prior advised to ACAP? Yes No Please indicate the areas of impairment: Hearing Vision Mobility Learning Psychological/Psychiatric Medical Other (please specify): Have you verified that the partner institution has services and facilities available to support you? Yes No ACAP Student Exchange Abroad (Outbound) Application Form 2012 3 of 12
8. Emergency contact details while on exchange with partner institution Name: Relationship: Telephone number: Email: I authorise ACAP to seek appropriate medical care for me, via the partner institution, as a matter of urgency, in the event of circumstances during on-campus classes at the partner institution requiring urgent medical care when it is not possible to contact my emergency contact. 9. Application checklist Check that you have: Completed all sections of the Application form and signed it Kept a copy of the Application form and all attachments Confirmed the units you have selected at your partner institution will be delivered in English (or a language you are competent in academically) Researched the living costs in the partner country and can make arrangements to cover these for the duration of your exchange Check that you have attached: Your ACAP Application including study plan approved and signed by your Head of School on this form Your partner institution application form completed with attachments Attachment 1 - Your statement of purpose (500 words) saying why you wish to study on student exchange at the partner institution Attachments 2 and 3 - two academic references in support of your application Letter of Nomination/Approval from your Head of School A copy of your passport with an expiry date of at least 6 months after your intended return 10. Privacy statement ACAP collects, stores and uses personal information for the purposes of administering prospective, current and graduate student admissions, enrolment and education. From time to time, ACAP may share your personal information within the Navitas Group and we may use that information to offer or notify you of products, services or other information that we reasonably believe may interest you. We will not do so if you tell us not to. We may contact you via post, telephone, email, SMS or MMS in relation to these marketing offers. ACAP may also share your information with third party providers, such as market research firms or electronic storage providers, who are engaged to provide certain services to ACAP. Where information is disclosed to third parties, ACAP will not allow the use of your information for any purpose other than the purpose for which it was disclosed. You have the right to access to and alteration of the information concerning yourself in accordance with the Privacy and Personal Information Act, 1988 (NSW). For more information please refer to http://www.acap.edu.au. 11. Declaration and terms of participation I give this declaration and agree to the terms set out below in support of my application to participate in ACAP s Exchange Abroad Outbound program. I declare that as an ACAP student participating in this exchange program I understand that I remain subject to the rules and regulations of ACAP whilst on exchange and will be required to abide by the rules and regulations of my partner institution while on exchange. I have read and understood the ACAP Student Exchange Program (Outbound) Information Guide I authorise ACAP to enrol me for the ACAP units that I attempt as part of my exchange program, for each semester of exchange approved, and acknowledge that I will incur tuition fees for these units. Please refer to Item 6 this application. I declare that the information I have supplied on this form is complete, true and correct. I understand ACAP is relying on this declaration and agreement in making any decision regarding participation in the program and that ACAP may change any such decision if this declaration is false. Applicant s signature:.. Date (day/month/year): ACAP Student Exchange Abroad (Outbound) Application Form 2012 4 of 12
12. Submitting this Application Send or hand in this completed and approved ACAP application together with your completed partner institution application to: (PLEASE KEEP A COPY OF ALL DOCUMENTATION SUBMITTED FOR YOUR RECORDS) ACAP Registrar Locked Bag 11 Strawberry Hills, NSW 2012 OR Student Administration Level 5, 11 York Street Sydney 2000 Please contact ACAP s Registrar s Office if you require further information or help completing your application form: Email: international@acap.edu.au International: +61 2 8236 8059 You will receive an acknowledgement of receipt from the Registrar s Office within 3 business days of the Registrar receiving your application. If you do not receive this, please contact the Registrar s office at the contact details above. When will you know application outcome? If the ACAP application has had initial approval, is complete with all the relevant original or certified documents attached and you have fully completed your partner institution application and attachments, the Registrar s Office will send both applications to your Head of School for final approval. The Registrar s Office will: Advise you of outcome and, if application approved, Submit your partner application to the overseas partner institution on your behalf. Please allow several weeks for this process and for the partner institution to advise the outcome of your application. NB: It is important for you to be aware that although most students' applications are accepted by the partner institution, the partner institution has the final say in accepting your application. ACAP Student Exchange Abroad (Outbound) Application Form 2012 5 of 12
ACAP Student Exchange Abroad Outbound Application Form Statement of Purpose Attachment 1 (Once completed, this attachment needs to remain part of your ACAP application for final approval by your Head of School or designate) Statement of Purpose Attachment 1 Full name of applicant (student): Student ID number: Campus and School: Telephone: Email: What is your academic and personal motivation for studying on exchange abroad? (approx. 200 words) ACAP Student Exchange Abroad (Outbound) Application Form 2012 6 of 12
What do you hope to achieve on a personal and professional level from exchange? (approx. 200 words) ACAP Student Exchange Abroad (Outbound) Application Form 2012 7 of 12
Please add any further comments you think would be helpful in determining your suitability for exchange as an ambassador for ACAP (approx. 100 words) ACAP Student Exchange Abroad (Outbound) Application Form 2012 8 of 12
ACAP Student Exchange Abroad Outbound Application Form Academic Reference Attachment 2 (Once completed, this attachment needs to remain part of your ACAP application for final approval by your Head of School or designate) Academic reference Attachment 2 Full name of applicant (student): Student ID number: Name of referee: Title/position: College and School: Telephone: Email: How long, and in what capacity, have you known the applicant? ACAP Student Exchange Abroad (Outbound) Application Form 2012 9 of 12
Please add comments which you feel would be helpful in determining the suitability of the applicant for an overseas study experience. Only staff related to the selection of the student for the overseas program will view this document. Academic Reference Attachment 2 ACAP Student Exchange Abroad (Outbound) Application Form 2012 10 of 12
ACAP Student Exchange Abroad Outbound Application Form Academic Reference Attachment 3 (Once completed, this attachment needs to remain part of your ACAP application for final approval by your Head of School or designate) Academic reference Attachment 3 Full name of applicant (student): Student ID number: Name of referee: Title/position: College and School: Telephone: Email: How long, and in what capacity, have you known the applicant? ACAP Student Exchange Abroad (Outbound) Application Form 2012 11 of 12
Please add comments which you feel would be helpful in determining the suitability of the applicant for an overseas study experience. Only staff related to the selection of the student for the overseas program will view this document. Academic Reference Attachment 3 ACAP Student Exchange Abroad (Outbound) Application Form 2012 12 of 12