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  • Topic: Given name, Japan, Personal name
  • Pages : 12 (1949 words )
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  • Published : September 6, 2013
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Student Exchange Application Form

I. Applicant Information
1. Home University:   University of Wisconsin Oshkosh  2. Name of Department: (MAJOR):    
3. University Address: 800 Algoma Blvd
City / State Oshkosh, WI Country USA Postal Code 54901  4. Family Name: (This is your LAST name):    
Given Names: (This is your FIRST name):
5. Name in Chinese Characters (if applicable): n/a
6. Date of Birth:      Year          Month          Date    7. Gender:   Male   Female 8. Nationality: U.S. Citizen 9. Native Language: English
10. Email:
11. Current Address:     
City / State                  Country USA Postal Code                      Phone: Country Code(1)( )  Mobile: Country Code(1)( ) 12. Mailing Address(if different from above):                                              

City / State                 Country USA Postal Code               Phone: Country Code(1)( ) Mobile: Country Code(1)( ) 13. Emergency Contact Person:                    Relationship to you:                          Emergency Contact Address:     

City / State       CountryUSA Postal Code       Phone: Country Code(1)( ) Mobile: Country Code(1)( )

II. Program of Study
1. Program Commencement: Spring (April) Fall (September)
2. Language Basis: English Japanese
3. College Choice: College of Asia Pacific Studies (APS) College of International Management (APM) 4. Period: 1semester 1 year

III. Education History
Have you completed 12 years of official education? Yes   No   expected completion date: completed
Total years of Education
Primary school           years  
Junior high school         years  
High school           years  
University level         years  
Others (               )        years   1. Type of School (Degree you will receive upon completion)
University (Bachelors Degree)  Graduate School (Master’s Degree) Junior College (Degree Course, Associate Bachelor Degree)   Vocational/Technical College (Certificate Course, Vocational School, etc) Other (Please explain in detail):                   2. Language you were taught in: English

3. Title of Degree:                    Obtained    
 Scheduled to Obtain Date:         Yr       M        D

IV. Employment History

If you are currently working or have been employed previously, please complete details below. Part-time work must not be included. Company Name and Address:       
Started (yy/mm)      Competed (yy/mm)       Responsibilities:
V. Declaration and Signature

I understand that the University may change or cancel any decision if any incorrect or incomplete information is given. Submitted documents for this application will become the property of the University and will not be returned to me. I hereby declare that all information provided are true and correct. Date:       Applicant’s Signature:                        [pic]

Application Essay

Please write the reason/s why you wish to study in APU.
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