Outbound Exchange Application

Name(Required)

First Last Pronouns

Student ID #(Required)

Current Year of Study(Required)

First Year

Second Year

Third Year

Fourth Year or higher

Program of Study(Required)

Personal Email(Required)

Enter Email Confirm Email

Date of Birth(Required)

Language Proficiency(Required)

Please indicate the languages that you know fluently and are comfortable taking upper-year university courses taught in those languages.

How did you hear about the Student Exchange Program?(Required)

Study Abroad Fair

Fall Preview Day

Spring Open House

Smart Start

Information Session

Posters

Social Media

Friends/Family

Other

Exchange Duration

Indicate the year for which you are requesting an exchange.(Required)

Indicate the duration for which you are requesting an exchange.(Required)

Full Year (Fall & Winter)

Fall

Winter

Dual Placement (full-year exchange, but different university for each semester)

Partner Institution Selection

Please rank your choices. Be sure to review the Placement Chances Guide before making your selections.

First Choice(Required)

Second Choice(Required)

Third Choice(Required)

Consortium Host Institution(s)

If you have selected a consortium such as NSE, UMAP, or ORA as one of your choices, please indicate the host institution(s) that you are applying for. (Example: NSE - Oklahoma State University, University of Hawaii at Manoa, etc.)

Host Institution Course List(Required)

Host Institution

Course Code & Title

For each of the host institutions that you have listed in your application, please list 5 courses at each host institution that you are interested in taking. Links to courses can be found at https://brocku.ca/international/mobility/outbound/partner-institutions/ If you need help in finding the course list, please contact us at exchanges@brocku.ca Note: You do not need to list courses for Ontario/Rhône-Alpes Exchange Program (ORA), National Student Exchange (NSE), and Killam Fellowships Program on this application.

Contact Details

Permanent Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student Declaration

Required Supplemental Documentation

Statement of Purpose(Required)

Max. file size: 29 MB.

Provide a one-page, double-spaced, statement of your personal, academic, and professional reasons for wanting to participate in the Brock Student Exchange Program.

Copy of your Brock University Program Plan(Required)

Max. file size: 29 MB.

Obtain your program plan from your Academic Advisor.

Proof of Application Fee Payment(Required)

Max. file size: 29 MB.

Please submit your receipt of proof of payment for the Student Exchange Program Application here.

Privacy Statement

Brock University protects your privacy and your personal information. The personal information requested on this form is collected under the authority of The Brock University Act, 1964, and in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA) for the administration of the University and its programs and services. Direct any questions about this collection to Brock International Services, at exchanges@brocku.ca

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