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Outbound Exchange Application

Personal Details
* Required
First Name Last Name
Student ID # * Required
Brock Email * Required
Enter Email Confirm Email
Personal Email * Required
Enter Email Confirm Email
Languages * Required
Please select 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
- Fall Preview Day
- Spring Open House
- Smart Start
- LEAP
- Vendor Fair
- Classroom Presentation
- Information Session
- Posters
- Social Media
- Friends/Family
- International Mobility Fair
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
- Winter
Partner Institution Selection (Full Year)
Please rank your choices:
First Choice * Required
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Partner Institution Selection (Fall Term)
Please rank your choices:
First Choice * Required
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Partner Institution Selection (Winter Term)
Please rank your choices:
First Choice * Required
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Partner Institution Selection (Dual Placement - Fall Term)
Please rank your choices for Fall Term of your dual placement:
First Choice * Required
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Partner Institution Selection (Dual Placement - Winter Term)
Please rank your choices for Winter Term of your dual placement:
First Choice * Required
Second Choice
Third Choice
Fourth Choice
Fifth Choice
Contact Details
Present Address * Required
Street Address City State / Province / Region ZIP / Postal Code Country
Permanent Address * Required
Street Address City State / Province / Region ZIP / Postal Code Country
Student Declaration
* Required
- I give permission to the Exchange 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 Services 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.
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.
Copy of your Brock University Program Plan (from your Academic Advisor) (Recommended)
Accepted file types: pdf.
Please visit your Academic Advisor to obtain a completed Program Plan
Program Fee * Required
- I understand that Brock International Services has a $125 Program Fee for this service. This fee is non-refundable.
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

Click here to take a Virtual Tour of Brock

More Information

International Brock Book 2019-20
International Student Support Book 2020
Brock Book 2019-20
International Chinese Brock Book 2019-20
Goodman School of Business Book 2019

Events calendar

FromAug 14

Travel & Quarantine Plan
7:30 AM – 8:30 AM
FromAug 19

Off the Clock with Brock
8:00 PM – 9:00 PM
FromAug 31

Trivia - Canada Edition
12:00 PM – 12:30 PM
FromAug 31

Trivia - Brock Edition
6:00 PM – 6:30 PM
FromSep 4

Netflix Viewing Party (Online)
5:00 PM – 7:00 PM

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