Fillable APPLICATION FORM Students Personal Data (Heriot-Watt University)

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APPLICATION FORM Students Personal Data (Heriot-Watt University)

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Attach INCOMING STUDENT EXCHANGE
APPLICATION FORM
Photograph
Heriot-Watt University is a Charity registered in Scotland, SC000278
FIELD OF STUDY: ......................................................................................
HOME INSTITUTION CODE: ................................................................... 2013-2014
(LIFELONG LEARNING PROGRAMME STUDENTS ONLY)
Lifelong Learning Programme – Erasmus Non - Erasmus
Student’s Personal Data
Title
First Name(s)
Surname
Sex
Date of Birth
Nationality
Date of Issue
Place of Issue
Country of Birth
Country of Residence
Marital Status
If you have a disability please tick here
Correspondence Address (with date you leave if applicable)
Home Address (if different)
Tel No :
Tel No :
E-mail:
E-mail :
Academic Details
Sending Institution (Name and full address)
Name of Departmental Coordinator
Name of Institutional Coordinator
Duration of stay
Start Date
No of Expected ECTS Credits
Briefly state the reasons why you wish to study abroad
Language Competence
Other Languages
(please detail as applicable)
I am currently
studying this
language
I have sufficient
knowledge to follow
lectures
I would have sufficient knowledge to
follow lectures if I had some extra
preparation
Work Experience Related to Current Study (if relevant)
Type of Work Experience
Name of Firm / Organisation
Dates
Country
Select
Select
Divorced
Select
Select
Select
Select
Select
Select
Select
Select
Select
Select
Heriot-Watt University is a Charity registered in Scotland, SC000278
Previous and Current Study
Diploma / degree for which you are currently studying
Number of higher education study years prior to departure
abroad
Have you already been studying abroad
If yes, when and at which institution?
Details of the Proposed Study Programme Abroad / Learning Agreement
Programme Unit/Course Code
Programme Unit/Course Title
Number of ECTS
Credits
Student’s Signature : Date :
Sending Institution - we confirm the proposed programme of study/learning agreement is approved.
Departmental Coordinator’s Signature Institutional Coordinator’s Signature
.......................................................................... ....................................................................
Date: ......................................... Date: ...........................................
Receiving Institution - we confirm the proposed programme of study/learning agreement is approved.
Departmental Coordinator’s Signature Institutional Coordinator’s Signature
.......................................................................... ......................................................................
Date: ......................................... Date: ............................................
This original completed application form along with a copy of your Transcript of Records (including full
details of previous and current higher education study) and copy of the I.D. page of your passport should
be mailed to:
Mrs Sue Moore, Institutional Exchange Co-ordinator, Academic Registry, Heriot-Watt University, Edinburgh Campus,
Edinburgh EH14 4AS, Scotland, United Kingdom
If you have any queries, please contact e-mail: hwuexchange@hw.ac.uk or Tel +44 131 451 4477/Fax +44 131 451 3896
Session Dates 2013/2014: 16 September 2013 – 6 December 2013 Semester 1 Teaching
9 - 20 December 2013 Semester 1 Exams
(23 December 2013 - 10 January 2014) (Break 1)
13 January 2014 – 4 April 2014 Semester 2 Teaching
(7 April 2014 - 25 April 2014) (Break 2)
28 April 2014 - 23 May 2014 Semester 2 Exams
Examination resits (if required) 7 August 2014 – 15 August 2014 inclusive
APPLICATIONS FOR SEMESTER 1 ENTRY SHOULD BE SUBMITTED NO LATER THAN FRIDAY 14 JUNE 2013
Select
Heriot-Watt University is a Charity registered in Scotland, SC000278
INCOMING STUDENT EXCHANGE
APPLICATION FORM
EQUAL OPPORTUNITIES MONITORING FORM 2013/2014
Heriot-Watt University is committed to equal opportunities for all, irrespective of age, colour,
disability, ethnic origin, gender, marital status, religious or political beliefs, sexual orientation or
other irrelevant distinction.
As part of the University’s policy commitments to promoting fair procedures for selection, it is
necessary to collect the information detailed below. This form will be detached from your
application and the information that you supply will not be considered in the assessment of your
application for admission as an exchange student. All information supplied will be treated in
confidence.
First Name(s)
Surname
Sex
DISABILITY Please tick one of the boxes below
No known disability
Mental Health Difficulties
Dyslexia
An unseen disability eg diabetes, epilepsy, asthma
Blind or partially sighted
Autistic Spectrum Disorder/Aspergers Syndrome
Deaf or hard of hearing
Multiple disabilities (please specify
)
Wheelchair user/mobility
difficulties
A disability or medical condition not
listed above (please specify)
Information declined
If you have any concerns about stating your disability you can contact Edel Mooney in confidence at Student Support
and Accommodation, Heriot-Watt University, Hugh Nisbet Building, Edinburgh Campus, Edinburgh EH14 4AS,
UK. Tel +44 131 451 3509 E-Mail E.Mooney@hw.ac.uk
ETHNIC ORIGIN Please tick one of the boxes below
WHITE
ASIAN –Chinese
BLACK – Caribbean
ASIAN – Other Asian Background
BLACK – African
MIXED – White & Black Caribbean
BLACK – Other Black Background
MIXED – White & African
ASIAN – Indian
MIXED – White & Asian
ASIAN – Pakistani
MIXED – Other Mixed Background
ASIAN – Bangladeshi
Information declined
Thank you for providing this information. Please return this form along with your completed Student
Exchange Application form.
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APPLICATION FORM Students Personal Data (Heriot-Watt University)

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Completed 13 October 2020

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