Application for International Student Exchange Program (Full Study Period)

This form can be used for undergraduate and postgraduate coursework students undertaking one or two full study periods of exchange.

Please note this form is for UniSA students only. Please review the application in full prior to commencing the application as you will not be able to save this form.

Application Deadline Dates:

UniSA Study Period 2 (Feb July): applications close 1 August of the year before you are planning to go on exchange

UniSA Study Period 5 (July Dec): applications close 11 January of the year you are planning to go on exchange

Applications received after these dates may be considered, please contact UniSA International.

Please note all fields marked with * must be completed in order to submit this form.

Your Personal Details

Correspondence will be sent to the mailing address that you have registered in myUniSA.
It is your responsibility to keep your contact details on myUniSA up to date.

Title:*
Family name:*
Given name(s):*
Student ID:*
Home phone:*
Work phone:
Mobile:
Email address:*
Date of birth:
Sex:	Male Female
Emergency Contact Person Emergency contacts are used by UniSA in the event that you are involved in a major incident overseas, or if we urgently require information about your whereabouts or your program and we are unable to contact you.
Name:*
Relationship:*
Address:*
Suburb/city:*
Postcode:*
Home Phone:*
Work Phone:
Mobile:
Email:

Your Current Enrolment Details

Program in which you are currently enrolled eg. Bachelor of Arts (International Studies):*
Current Year:*
School:*
Name of your Program Director:
Are you an international student?:*	Yes No

Exchange Destination and Timing List in order of priority, the institutions to which you wish to apply. Please note, you should thoroughly research your choices to ensure that relevant courses are offered at your nominated host institutions.
1.*
2.*
3.*

When do you plan to go on exchange?*
Year*		Number of study periods*

Host University Research and Statement of Purpose

In a paragraph, please provide us with your objectives for participating in an exchange program and the outcomes you expect.*

To ensure that you have thoroughly researched your nominated host universities, please list three or four courses you are interested in undertaking at your first and second preference. Please note, these are not necessarily your final choices, but an indication of your research and do not require approval from your Program Director at this stage.
First Preference	Course 1*
	Course 2*
	Course 3*
	Course 4
Second Preference	Course 1*
	Course 2*
	Course 3*
	Course 4

Financial Planning

Before submitting this application, you are expected to have completed some initial financial planning. Please note that all institutions in the USA require proof of finances of approximately AUD$7,000 to $9,000 as part of their application process.
Do you currently receive Youth Allowance, Austudy or Abstudy?:	Yes No
If yes, what is your number?:
This information is required so that UniSA International can supply appropriate documentation for you to give to Centrelink so your payments continue while you are on exchange.

UniSA's International Student Exchange Program Information

How did you find out about UniSA International Student Exchange Program?*
Other (please list):

UniSA Academic Staff Member Recommendation

All students applying to go on exchange must arrange for a University of South Australia academic staff member who knows them to provide a reference supporting their application to participate in the UniSA International Student Exchange Program. Please email the academic recommendation form (see below) to an appropriate academic UniSA staff member. You are responsible for following up with this staff member to ensure that they submit the academic recommendation form within two weeks of the submission of your exchange application. Your application will not be considered without an academic recommendation.
Academic Staff Member Referee Details
Name of referee:*
Title/Position:*
School:*
Telephone:*
Email:*

Academic Recommendation Form

Please copy and paste this information into an email to the academic staff member who will complete the recommendation for you.

Dear ...

Please find below the link to the Academic Recommendation Form . Please complete this form recommending me for the International Student Exchange Program.

My details are:

Full name

Student ID

Home/Work/Mobile phone

Email address

http://www-p.unisa.edu.au/intstaff/exchangestaff/acarecommendation.asp
(staff access only)

Conditions of Participation in the International Student Exchange Program

As a University of South Australia student participating in a student exchange program, I understand that I remain subject to the rules and regulations of the University of South Australia.

I also undertake to:

accept financial responsibility for all of my personal expenses, including accommodation, if applicable, during the exchange period
complete any pre-departure and/or academic preparation specified by my School and UniSA International
arrange suitable travel, including appropriate visas, personal and medical arrangements and insurance provisions for myself
arrange for my University of South Australia enrolment fees to be paid on my behalf each study period while I am away
abide by advice from the UniSA International office regarding student contribution payments, re-enrolment proxies and examination assessments
provide the UniSA International office with contact details within one week of arrival at the host institution
advise the UniSA International office and my Program Director of any changes to my academic program while overseas in accordance with the applicable University of South Australia dates and Divisional regulations
fulfil my role as an ambassador for the University of South Australia, respect the culture, abide by the laws of the host country and by the regulations of the host institution
consult international advisers promptly, and if necessary, consult the UniSA International office, should any problems arise in relation to my studies or otherwise during the exchange program
submit a report on my overseas experience within four weeks of my return to UniSA and assist other outgoing students in their decision-making and planning to go overseas on exchange

I understand that failure to abide by these conditions may result in disciplinary action by the University of South Australia and/or the host institution, and that it may also result in delays in the transfer of academic credit to the University of South Australia.

I accept the terms and conditions listed above:*

Yes No

Student Declaration

I agree to inform the UniSA International office immediately if there is any change to the information that I have given in this application.
I understand that the University of South Australia may vary or cancel any decision it makes if the information I have given is incorrect or incomplete.
I declare that the information provided by me in this application is true and complete.*

Yes No

Date:*

Checklist! - In order for your application to be considered you must ensure that:

all sections of the application form are complete
the academic recommendation form is emailed by you to an appropriate staff member for completion
the staff member sends the academic recommendation to UniSA International within two weeks of the submission of your application
two passport sized photographs (with your name and student ID number written on the back of each) are sent to UniSA International within two weeks of submitting your application

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