International Exchange Application Form

Personal Background

Name

First Name

Preferred First

Middle Name

Last Name

Suffix

Other Last Names Used

Address

Permanent Address

Country

Street

City

Region

Postal Code

Mailing Address

Same as Permanent Address

Country

Street

City

Region

Postal Code

Contact Information

Email Address

Home Phone

Mobile Phone

May we text you?

Yes

Biographical Information

Legal Sex

Personal Pronouns

Birthdate

Citizenship Information

Primary Citizenship

Dual Citizenship

Are you a U.S. Permanent Resident?

Yes

City of Birth

Birth country/region/territory

Social Security Number (omit dashes)

Academic Plans

Please use this section to outline your academic plans while at Westminster.

I plan to take courses in

Fall 2022

What institution (college or university) do you currently attend?

Institution Name
Begin typing the name of your institution, and select from the options presented.
If your institution is not listed, you can type it out here.

Institution City

Institution State/Province

Institution Level of Study

Have you attended any other institutions (colleges or universities) that you need to add?

Yes

Institution Name
Begin typing the name of your institution, and select from the options presented.
If your institution is not listed, you can type it out here.

Institution City

Institution State/Province

Institution Level of Study

Do you need to add more institutions (colleges or universities)?

Yes

Institution Name
Begin typing the name of your institution, and select from the options presented.
If your institution is not listed, you can type it out here.

Institution City

Institution State/Province

Institution Level of Study

Disciplinary History

Have you ever been found responsible for a disciplinary violation at any secondary or postsecondary school you have attended, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution?

Yes

Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.

Is an investigation pending related to academic misconduct or behavioral misconduct that, if proven, could result in your probation, suspension, removal, dismissal, or expulsion from the institution?

Yes

Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.

Have you ever been convicted of a misdemeanor, felony, or other crime?

Yes

Please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.

Review

By submitting this application, I certify that all of the information provided is my own work, factually true, and honestly presented. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation or expulsion, should the information I certified be false.

Signature

Date

International Exchange Application Form

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