Fillable Exchange-application Exchange Application Instructions

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Exchange-application Exchange Application Instructions

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  • 18 check-boxes
  • 125 other fields

Country of origin: US
File type: PDF

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Application Deadlines:
California State University, Chico
EXCHANGE Application Instructions
Fall Semester: DĂƌĐŚ
1
ϱƚŚ
Spring Semester: October 1st
'ŝǀĞŶƉƌŽĐĞƐƐŝŶŐ ƚŝŵĞƐĂƚ ĐŽŶƐƵůĂƚĞƐƚŽ ŝƐƐƵĞǀŝƐĂƐ͕ ƐƚƵĚĞŶƚƐĂƌĞƐƚƌŽŶŐůLJƌĞĐŽŵŵĞŶĚĞĚ ƚŽ ĂƉƉůLJ
ĂŶĚ ƐƵďŵŝƚĂůů ƐƵƉƉŽƌƚŝŶŐĚŽĐƵŵĞŶƚƐĞĂƌůLJ͘
Application Checklist:
Ύ
Completed and signed application
*
^ͲϮϬϭϵZĞƋƵĞƐƚĨŽƌŵǁŝƚŚFinancial support documentation
*
Copy of Passport Picture Page
*
Official transcriptŽĨĂĐĂĚĞŵŝĐƌĞĐŽƌĚ
1
*
Proof of English language proficiency
*
One recent Passport sized photograph
*
Course Request Form
*
/ŶƚĞƌŶĂƚŝŽŶĂůƵĚĚLJWƌŽŐƌĂŵYƵĞƐƚŝŽŶŶĂŝƌĞ
ŽŵƉůĞƚĞĚŝŐŝƚĂůůLJͲƐŝŐŶĞĚĞůĞĐƚƌŽŶŝĐĨŽƌŵƐŵĂLJďĞƐƵďŵŝƚƚĞĚĂůŽŶŐǁŝƚŚƐĐĂŶŶĞĚŝŵĂŐĞƐŽĨ
ƐƵƉƉŽƌƚŝŶŐĚŽĐƵŵĞŶƚƐĂƐĞͲŵĂŝůĂƚƚĂĐŚŵĞŶƚƐƚŽĞdžĐŚĂŶŐĞΛĐƐƵĐŚŝĐŽ͘ĞĚƵ͘
ƉƉůŝĐĂƚŝŽŶŵĂƚĞƌŝĂůƐĐĂŶĂĚĚŝƚŝŽŶĂůůLJďĞƐĞŶƚďLJƉŽƐƚƚŽƚŚĞ^h͕ŚŝĐŽ^ƚƵĚLJďƌŽĂĚKĨĨŝĐĞ͘
;ϭͿƉƉůŝĐĂŶƚƐŵƵƐƚƐƵďŵŝƚĂŚĂƌĚĐŽƉLJŽĨĂŶŽƌŝŐŝŶĂůĂĐĂĚĞŵŝĐƚƌĂŶƐĐƌŝƉƚ͘
Financial Requirements:
zŽƵŵƵƐƚƉƌŽǀŝĚĞƉƌŽŽĨŽĨĨŝŶĂŶĐŝĂůƐƉŽŶƐŽƌƐŚŝƉĨŽƌeducational ĂŶĚƉĞƌƐŽŶĂů
expenses while in the US of $1ϱ,ϰϬϬ (US) to cover all expenses for ŽŶĞ year,
excluding summer enrollment͘KŶĞƐĞŵĞƐƚĞƌŽĨƐƚƵĚLJƌĞƋƵŝƌĞƐŵŝŶŝŵƵŵ
ƉƌŽŽĨŽĨĨƵŶĚƐŽĨΨϳ͕ϳϬϬ;h^Ϳ͘
English Proficiency:
Allundergraduateapplicantswhohavenot completedthreeyears of academic
study at the secondary level or above in Anglophone countries (English
spoken in the home) must submit evidence of English language
proficiency.
We accept a TOEFL score of 61ibt/500pb͕ IELTS band score of 6; Žƌ
ŶŐůŝƐŚĨĂĐƵůƚLJůĂŶŐƵĂŐĞĂƐƐĞƐƐŵĞŶƚĨƌŽŵĂŚŽŵĞƵŶŝǀĞƌƐŝƚLJ͘
EŽƚĞ͗
dŚŝƐĂƉƉůŝĐĂƚŝŽŶŝƐĨŽƌ^h͕ŚŝĐŽdžĐŚĂŶŐĞƐƚƵĚĞŶƚƐĨƌŽŵĂPartner Institution
ONLY. If your University does not have a partnership with us, then please
contact the CSU, Chico Office of International Education.
CALIFORNIA STATE UNIVERSITY, CHICO
International Exchange Student Application - J visa students only
Mailing Address: Study Abroad Office
zŽƵƌŶĂŵĞĂƐ
shown on your
passport:
Last/Family Name
First/Given Name
Middle Name
ĂůŝĨŽƌŶŝĂ^ƚĂƚĞhŶŝǀĞƌƐŝƚLJ͕ŚŝĐŽ
400 W First Street, Chico, CA 95929-0680
Phone: +1 530-898-5415 Fax: +1
530-898-6889
E-mail: exchange@csuchico.edu
Website: http://www.csuchico.edu/studyabroad/exchange/index.shtml
Female
&Ăůů
ΎCountry of Citizenship
>ŝƐƚůůƉƉůŝĐĂďůĞ
Date of Birth (mm/dd/yy)
C
Name as shown on transcripts or test scores, if different:
Address information: We need your permanent and your mailing addresses. The permanent street address is required if you are admitted to Chico for issuance of the DS-2019
form. The permanent address CANNOT be a U.S. address, it must be in your home country.
ity & Country of Birth
^ƉƌŝŶŐ
&ĂůůΘ^ƉƌŝŶŐ
zĞĂƌ
Dale
WĞƌŝŽĚŽĨ^ƚƵĚLJ
Permanent street address
Permanent street address
Permanent City
Postal Code
PostalCode
Permanent State/Province
Permanent Country
Telephone Numbers (include country code)
ŵĂŝůĚĚƌĞƐƐ;ĞƐͿ͗ůůĐŽƌƌĞƐƉŽŶĚĞŶĐĞĚƵƌŝŶŐƚŚĞĂĚŵŝƐƐŝŽŶƉƌŽĐĞƐƐǁŝůůďĞǀŝĂĞŵĂŝů͘ĞƐƵƌĞƚŽůŝƐƚĂŶĞŵĂŝůĂĚĚƌĞƐƐǁŚĞƌĞLJŽƵĐĂŶƌĞĐĞŝǀĞĞŵĂŝůƐǁŝƚŚĂŶ@csuchico.edu extension.
If you change your e-mail address please be sure to notify us immediately. List the primary e-mail address first if you have more than one.
E-mail Address(es):
Mailing address
Mailing address
Mailing City
Mailing State/Province
DĂŝůŝŶŐŽƵŶƚƌLJ
Major: WůĞĂƐĞƌĞĨĞƌƚŽƚŚĞhŶŝǀĞƌƐŝƚLJĂƚĂůŽŐĨŽƌĂůŝƐƚŽĨďĂĐŚĞůŽƌĚĞŐƌĞĞ
Major
ƉƌŽŐƌĂŵƐ͘^ĞůĞĐƚΗhŶĚĞƌŐƌĂĚƵĂƚĞΗ ĐĂƌĞĞƌĂŶĚΗDĂũŽƌΗƉƌŽŐƌĂŵƚLJƉĞ͘EŽƚĂůů
ƉƌŽŐƌĂŵƐĂƌĞŽƉĞŶƚŽdžĐŚĂŶŐĞƐƚƵĚĞŶƚƐ͕ƐƵĐŚĂƐΗEƵƌƐŝŶŐΗĂŶĚΗDƵƐŝĐͲZĞĐŽƌĚŝŶŐ
Option
ƌƚƐΗ͘/ŶƋƵŝƌĞǁŝƚŚƚŚĞ^h͕ŚŝĐŽ^ƚƵĚLJďƌŽĂĚKĨĨŝĐĞĨŽƌĐƵƌƌĞŶƚƌĞƐƚƌŝĐƚŝŽŶƐ͘
0, First-Time Freshman no college coursework after high school
3, Junior, less than 3 but more than 2 years of study completed
Class Level - Select one:
Complete based on
the number of units
you plan to have completed
when you enter CSU, Chico
1, Freshman transfer, less than 1 full year of study completed
4, Senior, less than 4 but more than 3 years of study completed
2, Sophomore, less than 2 but more than 1year of study completed
5, 2nd Bachelor's, Bachelor's or equivalent completed
ΎNOTE: US Citizens are not eligible for exchange at CSU, Chico
Educational History:
List all ĐŽůůĞŐĞƐͬuniversities attended. Include the name of the ŝŶƐƚŝƚƵƚŝŽŶ and the country where it was locatedĂŶĚ dates you attended mm/yy to mm/yy͘
Completion of high school is required for admission.
Degree Objective: ůůĞdžĐŚĂŶŐĞĂƉƉůŝĐĂŶƚƐĂƌĞĂĚŵŝƚƚĞĚĂƐŶŽŶͲĚĞŐƌĞĞƐĞĞŬŝŶŐƐƚƵĚĞŶƚƐ͘ĞŐƌĞĞƉƌŽŐƌĞƐƐĂƚƐƚƵĚĞŶƚƐΖŚŽŵĞƵŶŝǀĞƌƐŝƚLJǁŝůůďĞĚĞƚĞƌŵŝŶĞĚďLJĂŶ
advisorĂŶĚͬŽƌĨĂĐƵůƚLJat their home university.
Home University͗
Required:
Did yo u graduate
from high
school?
No Explain
Yes
Date of Graduation (mm/yy)
Name of School/College/University Country where located
ĂƚĞƐŽĨƚƚĞŶĚĂŶĐĞ
ŵŵͬLJLJƚŽŵŵͬLJLJ
Level of study and degree earned
high/secondary school, college, university
University/College Courses in progress or planned: Directions: if you are applying for a fall semester list courses you will complete in the prior spring and summer terms, all other
courses must be received on an official transcript. Ex: Applying for fall 2014 list spring and summer 2014 courses below, courses taken fall 2013 and before must be received on an official
transcript. If you are applying for a spring semester list below the courses you will complete in the prior fall semester, all other courses must be received on an official transcript. Ex: Applying
for spring 2015 list below courses planned fall 2014, all other courses must be on an official transcript.
Name of College or University
ex. XYZ University
Course # & Title
ex. MATH 2111, Calculus
dĞƌŵ
Ğdž͘^ƉƌŝŶŐϮϬϭϰ
# & type of Units/Credits
ex. 4 ĐƌĞĚŝƚƐͬd^
California State University,
Chico
International Exchange Financial
Full name as shown
on application:
J- Visa Students Only
(revised date: 6.19.19)
Evidence
of
adequate funds
to
meet
the financial
obligations
of
enrollment
at
California State University, Chico is required by the U.S. Department of
Homeland Security for issuance of a DS-2019.
Please complete this form
in full
using U.S. dollars when listing
funds.
Check
https://www.csuchico.edu/studyabroad/exchange/accepted/index.shtml for
current support
requirements.
Section
A:
Applicant
Information
Please select
Correct responses:
Undergraduate
Applicant
Graduate
Applicant
Funds for First Year
and source
of funding while
studying
at
CSU,
Chico
(Check appropriate
boxes)
Funds
from
parents, relatives,
or
private sponsor (complete all sections, and
see
U.S.
$
Bank Verification
of Funds**)
Government
or
private scholarship, attach
letter of
award. L
etter
to
include years
U.S.
$
of
study, major,
billing
address, addressed
to
CSU,
Chico.
Section B: Financial Certification
of
Sponsor
(
If sponsored
by
a parent, relative,
or other
private source: complete this section
or
submit
letter from sponsor)
Name
of Sponsor
Relationship
to you
Sponsor's Guarantee: "I guarantee
the
funds indicated
in
Section A
will
be available
for the
above named student and any dependents
for the first
year
of
education
at
California State University, Chico and a comparable
amount
is
committed for
each year necessary
to
complete
the
degree. Further,
I guarantee
the
student
will not
become a
public charge."
Confirm
with
signature
or by typing in
your
name:
Date
signed
**Bank Verification
of Funds
If
you have a private sponsor (parent, relative,
or
family friend),
or if
you are supported
by
your
own
funds, we need a
letter
(non-binding
on the
bank)
from
the
appropriate bank,
in
English,
that
confirms
they/you
appear financially capable
of
meeting
the commitment of
funds promised
in
Section
A
above.
If the
funds
originate
from
outside
the
U.S.
please include
in the letter
a statement regarding restrictions
that
could prevent release
of
these funds
to
the
U.S.
Section C: Signature
of
Applicant
- required
"I
fully
understand
the amount of
money necessary
for
each year
of
study
to
cover all educational and
living
expenses
while attending
California State University, Chico and
I
certify
the
answers
on
this
form
are
correct."
Confirm
with
signature
or by typing in
your
name:
Date
signed
Your
own
funds (complete sections A,
C, and see Bank
Verification
of Funds**)
U.S.
$
English Language Proficiency: Evidence of English language proficiency is required of all students whose native language (language spoken in the home) is other than
English. We accept TOEFL(500pb/61ibt) or IELTS (6.0) score; 3 years of study in an English speaking country at the secondary level or higher; ŽƌĂůĞƚƚĞƌĨƌŽŵĂŶŶŐůŝƐŚƉƌŽĨĞƐƐŽƌ͘
I have evidence of English language proficiency.
^ĞůĞĐƚ and complete ƚŚĞappropriate selection
Native speaker or 3 years of academic study at secondary level or higher from one of the approved countries, select from list:
United States of America
Qualifying TOEFL score
Date mm/dd/yy
Writing Total score
Qualifying IELTS score
Date mm/dd/yy
Writing Overall score
>ĞƚƚĞƌĨƌŽŵŶŐůŝƐŚĨĂĐƵůƚLJŽĨŚŽŵĞƵŶŝǀĞƌŝƐƚLJĐŽŶĨŝƌŵŝŶŐĂĐĂĚĞŵŝĐƉƌŽĨŝĐŝĞŶĐLJĞƋƵŝǀĂůĞŶƚƚŽŵŝŶŝŵƵŵdK&>ͬ/>d^ƐĐŽƌĞƐŶĞĐĞƐƐĂƌLJĨŽƌƐƵĐĐĞƐƐĨƵůƉĞƌĨŽƌŵĂŶĐĞĂƚƚŚĞ
ƵŶŝǀĞƌŝƐƚLJ͘
How did you hear about Chico?
Why did you apply to Chico?
No
Yes
Disability Support Services: (optional) If you have a physical, ĚĞǀĞůŽƉŵĞŶƚĂů, or learning disability͕ would you like information regarding available services?
CERTIFICATIONS: Please read these carefully and then sign if you can agree to these statements.
Health Insurance: If admitted I agree to ƉƵƌĐŚĂƐĞĂƉŽůŝĐLJŽĨĨĞƌĞĚƚŚƌŽƵŐŚƚŚĞhŶŝǀĞƌƐŝƚLJ,ĞĂůƚŚĞŶƚĞƌƵƉŽŶĂŶĚƉƌŽǀŝĚĞƉƌŽŽĨƵƉŽŶŵLJĂƌƌŝǀĂů. I understand that failure to provide
such proof will prevent enrollment or cause my disenrollment from classes. dŚĞƵƐĞŽĨŵLJŚŽŵĞĐŽƵŶƚƌLJŝŶƐƵƌĂŶĐĞ͕ŽƌĐŽŵƉĂƌĂďůĞƉŽůŝĐLJ͕ŝŶůŝĞƵŽĨ^h͕ŚŝĐŽŝŶƐƵƌĂŶĐĞ͕ŵĂLJďĞ
ĐŽŶƐŝĚĞƌĞĚƵƉŽŶĂĚǀĂŶĐĞƌĞƋƵĞƐƚTo fulfill this condition of my enrollment, I must show proof of insurance coverage for accident and illness with a minimum of $ϭϬ0,000US,
provision for medical evacuation with a minimum of $ϱ0,000US and provision for repatriation of a deceased insured person with a minimum of$Ϯϱ,Ϭ00US.
Accuracy of Application: I certify under penalty of perjury that I have provided complete and accurate responses to the items on this application. I further certify (swear) all
official documents submitted by me in connection with this application are authentic and unaltered records that pertain to me. I authorize release of any information submitted by
me in connection with this application to any person, firm, corporation, association, or government agency but only to verify or explain the information, obtain pertinent records,
or in connection with perjury proceedings. / understand that any misrepresentation may be cause for denial or cancellation of admission or enrollment. I understand that my
signature is certification of the accuracy and completeness of the information I have provided.
Physical or digital signature Date (mm/dd/yy)
Location where signed
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signature
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Exchange-application Exchange Application Instructions

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Completed 11 April 2020

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