Aerial photo of Brescia University College

Exchange Application - Incoming

(Ms., Mrs., Miss., Mr.)
Have you previously applied to Brescia University College/Western University?*
Have you previously been a student at Brescia University College/Western University?*
Permanent Address
If you mailing address is different than your permanent address, please complete the following section.
Personal Information
Eg. Canada for 20 years.
Do you have a disability?*
This information is needed in case special facilities are required.
Current Academic Program Information
Academic Details for Exchange 
Period of Study*
Level of Study *
Residence Accommodation
Do you want to live in residence (Clare Hall) at Brescia?*
Do you need more information on off-campus housing options?*
Emergency Contact Information
(Ms., Mrs., Miss., Mr.)
Upon the completion of my Exchange Program at Brescia University College, I request that a final copy of my Academic Record from Brescia University College be sent to my home University.
I hereby certify that all the information provided on this application is true and complete. I understand that otherwise my admission to or registration in the University may be revoked.