STUDY ABROAD / INTERNATIONAL EXCHANGE STUDENT APPLICATION FORM
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1 Slicitud Tip STUDY ABROAD / INTERNATIONAL EXCHANGE STUDENT APPLICATION FORM Fr a nn-degree academic prgram F INSTRUCTIONS: This applicatin will nt be prcessed unless all the infrmatin has been prvided. PLEASE PRINT CLEARLY. PLEASE ENCLOSE THE FOLLOWING DOCUMENTS: Official certificate f Transcript sheet giving a cmplete list f the subjects studied and the results btained fr any prgrams yu have cmpleted r are currently enrlled in. Cpy f the identificatin page f yur passprt Mtivatin letter Curriculum vitae Letter frm university r ther language institutin certifying Spanish level B2. Cpy f yur health insurance with internatinal cverage Present upn yur arrival at campus Cpy f yur Immigratin permit Clr Pht 1. APPLICATION FOR: 2. PROGRAM: Study Abrad Exchange Hme Institutin Partner Institutin High-schl Undergraduate Graduate 3. PERSONAL INFORMATION: Family Name: First Name(s): Date f Birth: Gender: Male Female Citizenship: (As shwn in Passprt) Cuntry f Birth: Passprt Number: Issue date: Expiry date: Permanent address (in hme cuntry): Street City Zip Cde State/ Prvince Cuntry Telephne/mbile number: Cuntry cde City cde Number Infrmatin will be sent t this ; MAKE SURE YOUR INBOX IS AVAILABLE. Applicatin Frm Type F
2 4. EMERGENCY CONTACT: In case f emergency, please cntact (at least ne cntact must be frm yur hme cuntry and speak English): Name: Relatinship: Telephne/mbile number: Speak English: Yes N Cuntry cde City cde Number Name: Relatinship: Telephne/mbile number: Speak English: Yes N Cuntry cde City cde Number 5. HEALTH INSURANCE: It is a cnditin that yu keep an Internatinal Health Insurance fr the duratin f yur studies in Universidad TecMileni. The University ffers a lcal accident insurance, it is mandatry t purchase it, t knw abut the cst please cntact the Internatinal Office. D yu have an Internatinal Health Insurance? N Yes *Specify Health Insurance cmpany: I understand that I have t acquire an internatinal health insurance with the minimum cverage required and that I have t prvide a cpy t the Internatinalizatin Directin. Als, I acknwledge that I must acquire the lcal Health Insurance with cverage prvided by Universidad Tecmileni fr my whle perid in Mexic. 6. SPECIAL NEEDS AND MEDICAL HISTORY: D yu have any special needs r require special services during yur prgram (i.e., learning aids r facilities with handicapped access)? N Yes, which? Hearing Visin Learning Medical Mbility Other, specify: D yu have any chrnic prblem? N Yes, specify: Are yu under medicatin? N Yes, specify: Is it permanent r spradic? *Bld type: 7. PROPOSED ENROLLMENT AT UNIVERSIDAD TEC MILENIO: Hw lng d yu wish t study at Universidad TecMileni? T One Perid Tw Perids Three Perids Applicatin Frm Type F
3 Academic perid yu are interested in: Semestral Perid: Spring Summer Fall Semester (January - May) (January-July) (August - December) Trimester Perid: First Trimester Secnd Trimester Third Trimester (January-April) (May-August) (September-December) Campus f yur interest: Cancún Las Trres Querétar Mérida Why are yu interested in this campus? Academic ffer Lcatin in Mexic Facilites Other, specify: 8. ACADEMIC BACKGROUND: Title f yur current study prgram (academic majr): Current study year: 2 nd 3 rd 4 th 5 th (Please nte: Yu must submit an riginal academic transcript r certified cpy f yur academic transcript t verify yur current enrlment. The transcript prvided shuld indicate all subjects attempted, grades and awards achieved and an explanatin f the grading system used by the institutin.) 9. SPANISH LANGUAGE PROFICIENCY: If yur native language is Spanish cntinue with the next sectin. Otherwise, be sure t cmplete all the fields in this sectin. Imprtant: The student must have a B1 level f Spanish fr the exchange. Have yu previusly enrlled t a Spanish curse? Yes N If yes, level achieved: Have yu taken a Spanish prficiency test? Yes N N, but I am planning t take ne. Name f the Spanish test: Date f test: Test scre: Place: 10. DECLARATION: Applicatin Frm Type F
4 I understand that: Universidad TecMileni may btain fficial recrds frm any educatinal institutin I have previusly attended. I am fully respnsible fr any educatinal and living expenses while I study at Universidad TecMileni. Universidad TecMileni r the Mexican Gvernment cannt help me if I run shrt f funds. I agree: T cmply with the rules n admissin and enrlment f Universidad TecMileni. T immediately tell the Internatinal Office if there is any change regarding the infrmatin I have given in this applicatin. That my prgram enrlment may be terminated by Universidad TecMileni, if I fail t remain enrlled full time, fail t maintain minimum academic standards as defined by my hme institutin r Universidad TecMileni, r am I fund t be in vilatin f laws r regulatins f Mexic r Universidad TecMileni. I acknwledge that all statements in this applicatin are cmplete and accurate t the best f my ability. I have read, and understand the terms and cnditins f undertaking this prgram. I am aware that it is my respnsibility t btain all visas and t arrange air travel and husing. I declare that the infrmatin I have given in this applicatin frm and supprting dcuments is true and crrect, and that I have persnally signed this frm. Name f the Applicant Signature Date Name f the Applicant s Guardian Guardian s signature Date (Mandatry fr minrs) 11. PROPOSED ENROLLMENT AT UNIVERSIDAD TECMILENIO: Applicatin Frm Type F
5 Nte: Despite the prgram yu are least 8 credits at Universidad TecMileni, and a maximum f 48 credits in the semester. applying t, yu are required t undertake at Please list the curses yu wish t study: COURSE CODE FULL COURSE NAME COURSE APPROVAL (OFFICE USE ONLY) IMPORTANT: Keep in mind that there may be changes in yur curses prpsal, all curses will be cnfirmed at yu arrival at Tecmileni. *All applicatins will be acknwledged. Universidad Tecmileni reserves the right t make mdificatins t any infrmatin cntained within this publicatin, withut prir ntice. OFFICE USE ONLY ADMITTED NOT ADMITTED PI Number Crdinación de Admisines Internacinales Name: Signature: Date: Cmments: Applicatin Frm Type F
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