UNIVERSIDADE DE CAXIAS DO SUL
Assessoria de Relações Interinstitucionais e Internacionais
a
UCS
Rua Francisco Getúlio Vargas, 1130 – Bairro Petrópolis – CEP 95070-560 – Caxias do Sul – RS – Brasil
Telefone / Telefax PABX + 55 54 3218 2318 – E-mail [email protected] – www.ucs.br
FOREIGN STUDENTS APPLICATION FORM
ACADEMIC YEAR: ____________
Name of the programme: __________________________________
_______________________________________________________
FOTOGRAFIA
PHOTO
1. Student’s Personal data
Full name: ______________________________________________
_______________________________________________________________________
Gender: _________________________________________________________________
Date of birth: _____________________________________________________________
City / country of birth: ______________________________________________________
Residential address: _______________________________________________________
_______________________________________________________________________
Passport number: _________________________________________________________
Telephone number: _______________________ Mobile phone: _____________________
E-mail: _________________________________________________________________
2. Academic data
Home Institution name: ____________________________________________________
Telephone number: ________________________ Fax number: _____________________
Academic course complete name: ____________________________________________
Grade average: ___________________________________________________________
Contact person: ___________________________________________________________
Telephone number: _________________________ E-mail: ________________________
3. Host Institution data
Name of academic course: __________________________________________________
Name of the coordinator: ___________________________________________________
Telephone number: _________________________ E-mail: ________________________
Contact person at UCS: _____________________________________________________
Telephone number: _________________________ E-mail: ________________________
Gráfica da UCS – 130958
4. Details of the proposed study programme abroad
Host institution course unit
Course unit
credits
Home institution course unit
Course unit
credits
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2.
3.
4.
5.
6.
7.
8.
5. Commitment agreement
I accept the terms and conditions of the academic exchange program with Universidade de
Caxias do Sul. Should I be selected, I assume my personal expenses.
Name of the student: _______________________________________________________
Signature: _______________________________________________________________
Date: ___ /___ /______
6. Authorization
I authorize the student to participate in the academic exchange program between
Universidade de Caxias do Sul and our Institution.
Name of the person responsible for the international programs: ______________________
_______________________________________________________________________
Occupation: _____________________________________________________________
Signature: _______________________________________________________________
Date: ___ /___ /______
7. Documents included:
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Application form . . . . . . . . . . . . . . . . . . . . . . . . . (
Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (
School transcripts . . . . . . . . . . . . . . . . . . . . . . . . . (
Letter of intention (maximun 2 pages) . . . . . . . . . (
Passport copy (identification pages) . . . . . . . . . . . (
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Return this form and required documents to:
Assessoria de Relações Internacionais
Universidade de Caxias do Sul – UCS
Rua Francisco Getúlio Vargas, 1130 – Bairro Petrópolis – CEP 95070-560 – Caxias do Sul – RS – Brasil