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Outbound Exchange Application

Personal Details
Name * Required
First Last
Student ID # * Required
Current Year of Study * Required
- First
- Second
- Third
- Fourth or higher
Program of Study * Required
Brock Email * Required
Enter Email Confirm Email
Personal Email * Required
Enter Email Confirm Email
Date of Birth * Required
MM slash DD slash YYYY
Language Proficiency * Required

Please indicate the languages that you know fluently and are comfortable taking upper year University courses taught in those language(s).
How did you hear about the Exchange Program? * Required
- Study Abroad Fair
- Fall Preview Day/Spring Open House
- Smart Start
- Information Session
- Posters
- Social Media
- Friends/Family
Exchange Duration
Indicate the academic 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
First Choice * Required
Second Choice * Required
Third Choice * Required
Consortium Host Institution(s)

If you have selected a consortium 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 City State / Province / Region ZIP / Postal Code Country
Student Declaration
* Required
- I give permission to the Student Exchange Program Committee to order my Statement of Standing and look at my file in the Office of the Registrar.
* Required
- I acknowledge that if selected for the Exchange Program, I am representing Brock University as an Ambassador of Brock University and the Exchange Program.
* Required
- I acknowledge that if I am selected for the Exchange Program, that it is my responsibility to have researched the exchange schools listed on my application for academic suitability. I acknowledge that Brock International reserves the right to make the placement decisions for the Exchange Program and will discuss alternative exchange options, if placement at the schools listed on my application is not feasible.
- I acknowledge that I have met with my academic advisor in my academic department and understand how an exchange term will fit into my program plans and degree requirements.
Required Supplemental Documentation
Statement of Purpose (1 page, double-spaced, statement of your personal, academic, and professional reasons for wanting to participate in the Brock Student Exchange Program) * Required
Accepted file types: pdf, Max. file size: 29 MB.
Copy of your Brock University Program Plan (from your Academic Advisor) * Required
Accepted file types: pdf, Max. file size: 29 MB.
Please visit your Academic Advisor to obtain a completed Program Plan
Academic Reference Letter * Required
- I understand that an academic reference letter is required to complete the application, and it must be provided from an instructor who has taught you at Brock
*Letter should be provided on official letterhead. ** Guide to academic reference can be found here: https://brocku.sharepoint.com/:b:/s/BISTeam/EZI41QzSYulIk6YLQ_g_TvwBRR8p4z61nDzUYnwIHKWeaQ?e=txA8rG *** Reference letter can be sent to exchanges@brocku.ca from the referee; Drop off or mail to Brock International Center (2nd Floor) in a sealed envelope to the attention of the International Learning office. If referees have any questions, they can email exchanges@brocku.ca
Reference Letter (General) * Required
- I understand that a general reference letter is required to complete the application.
*Can be from anyone except relatives and friends ** Reference letter can be sent to exchanges@brocku.ca from the referee; Drop off or mail to Brock International Center (2nd Floor) in a sealed envelope to the attention of the International Learning office. If referees have any questions, they can email exchanges@brocku.ca
Application Fee * Required
- I understand that Brock International has a $55 Application Fee for the exchange program. This fee is non-refundable.
Application fee can be paid on the following website: https://Brocku.universitytickets.com/w/event.aspx?id=1985
Proof of Application Fee * Required
Accepted file types: pdf, Max. file size: 29 MB.
Please submit your receipt or proof of payment for the exchange 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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