Exchange Application - Outgoing

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First Name*

Last Name*

Date of Birth (dd/mm/yy)*

Student Number*

Western Email*

Phone Number*

Local Address (London)*

Permeant Address *If different from above.

Academic Information 

Degree/Program Modules (complete as appropriate)

Degree*

Honour Specialization

SpecialIzation

Major

Minor

Current year of study * Please Select First-year Second-year Third-year Fourth-year Fifth-year+

I am aware that my Academic Record will be reviewed and that consultation regarding my eligibility may take place with Brescia Academic Advisors and Faculty*

I agree

BE International Program Location Choices 

Please select top three location choices in order of preference.

Location Choice One* Please Select Ewha Womans University, South Korea (Exchange) Ewha Womans University, South Korea (Summer Program) LaSalle Beauvais Institut Polytechnique, France (Exchange) LaSalle Beauvais Inistitut Polytechinique, France (Summer Program) Mary Immaculate College, Ireland (Exchange) Stenden University, The Netherlands (Exchange) Universite Catholique de Lille, France (Exchange) Universite Catholique de Lille, France (Summer Program) University of the West Indies-Cave Hill Campus, Barbados (Exchange) Wesleyan College, Georgia, USA (Exchange) Zuyd University of Applied Sciences, The Netherlands (Exchange)

Location Choice Two* Please Select Ewha Womans University, South Korea (Exchange) Ewha Womans University, South Korea (Summer Program) LaSalle Beauvais Institut Polytechnique, France (Exchange) LaSalle Beauvais Inistitut Polytechinique, France (Summer Program) Mary Immaculate College, Ireland (Exchange) Stenden University, The Netherlands (Exchange) Universite Catholique de Lille, France (Exchange) Universite Catholique de Lille, France (Summer Program) University of the West Indies-Cave Hill Campus, Barbados (Exchange) Wesleyan College, Georgia, USA (Exchange) Zuyd University of Applied Sciences, The Netherlands (Exchange)

Location Choice Three* Please Select Ewha Womans University, South Korea (Exchange) Ewha Womans University, South Korea (Summer Program) LaSalle Beauvais Institut Polytechnique, France (Exchange) LaSalle Beauvais Inistitut Polytechinique, France (Summer Program) Mary Immaculate College, Ireland (Exchange) Stenden University, The Netherlands (Exchange) Universite Catholique de Lille, France (Exchange) Universite Catholique de Lille, France (Summer Program) University of the West Indies-Cave Hill Campus, Barbados (Exchange) Wesleyan College, Georgia, USA (Exchange) Zuyd University of Applied Sciences, The Netherlands (Exchange)

Duration and timing of international experience*

Full Year Exchange (2020-2021 Academic Year)

Fall Term Exchange (September 2020- December 2020)

Winter Term Exchange (January 2021 - April 2021)

Summer Program (Summer 2020)

Summer Program (Summer 2021)

Other

If you selected "other", please explain

Statement of Interest

Please provide an original statement (approx. 250 words) that describes how a BE International Experience will enhance your education and contribute to your future goals.*

I hereby certify that the following information is correct and can be verified upon request*

I agree

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