UNIVERSITÉ DU QUÉBEC À CHICOUTIMI
STUDENT EXCHANGE PROGRAM
APPLICATION FORM
A. STUDENT PERSONAL INFORMATION
Student I.D. Number Surname First name
INSTRUCTIONS
The Application Process:
Return the completed application to Études françaises by the deadline date. All sections must be
completed. Do not forget to include a one page personal statement. Your application will be
evaluated and you will be notified if you have been chosen for an interview.
Application deadline for 2017/2018: January 27, 2017
Pre-departure preparation:
If you are selected to participate in the Université du Québec à Chicoutimi Student Exchange
Program, you will be required to attend a pre-departure orientation session (PDO). You are also
expected to prepare yourself for your trip. Participants are responsible for the cost of travel,
supplementary health insurance, tuition and other incidental expenses.
If you move, you must notify the Études françaises office, 267 MacKinnon. If we cannot
contact you, you may not be allowed to participate in the program.
Be advised that:
Spaces are limited and are awarded on a competitive basis, subject to availability. Your application
does not guarantee that you will be interviewed or accepted.
You must maintain a 'B' average prior to your departure in order to participate in the exchange
program.
You will be required to attend a pre-departure orientation and sign a waiver prior to participating
in this exchange program.
If you apply by the deadline, you may be eligible for a Travel Scholarship based on your academic
record.
You will be required to pay full-time tuition fees and take four courses while on the Université du
Québec à Chicoutimi Student Exchange Program.
Note that you will receive a P(Pass) or F(Fail) in your transcript at UoG for each course you take at
UCAQ.
This form contains important information which you may need for future reference. Make
a copy and keep it in a safe place.
Student Number _________
B. PERSONAL AND ACADEMIC INFORMATION
Canadian Citizen Permanent Resident
Visa Student
Permanent Address
City/Town/Village Province/Territory/Region Country Postal Code
Area Code +
Phone Number
Current Address
City/Town/Village Province/Territory/Region Country Postal Code
Area Code +
Phone Number
E-mail Address
@uoguelph.ca
Academic Information
Current Semester Level Degree Program
2 3 4 5
6 7 8 9+
Specialization 1 Specialization 2
Anticipated semester of completion of current degree program Cumulative Average
Fall 20____ Winter 20____ Summer 20____ _____________%
Indicate the semester you will be going on the Student Exchange Program
Fall 20____ Winter 20____
C. ACADEMIC AND PERSONAL SUITABILITY
Please answer the following questions in the space provided.
1. Have you ever travelled, studied or worked in a culture other than your own? How did you
adapt and what did you learn? If not, what do you expect to learn from a program such as the
one offered at the Université du Québec à Chicoutimi?
2. Describe the ways in which you adapt to new environments.
3. Comment on your personal strengths and weaknesses:
D. REFERENCES
Please provide the names of two members of the campus community (preferably faculty or staff)
who would provide a reference for you. You do not need to attach reference letters.
Name Department
Extension
E. DECLARATION
I have read and understand all instructions and information related to this application.
I enclose an unofficial copy of my academic record and give the Études françaises permission to
access my academic record for verification.
ALL INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND COMPLETE
Student’s Signature Date (Year/Month/Day)
School of Languages & Literatures
Études françaises
University of Guelph
Guelph, ON
N1G 2W1
519-824-4120 ext. 53883
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