Application to Study on a Queen's University Multifaculty Exchange — 2015-16 NOTE: To participate on a Multifaculty Exchange, students must satisfy the eligibility requirements to study on an exchange as specified by their faculty/school of study at Queen's and have faculty/school approval from their faculty exchange coordinator. A list of faculty exchange coordinators can be found by visiting the Queen's International website. INSTRUCTIONS:Complete the entire form below. The supporting documents required as part of the application for the desired exchange (e.g. program application form, résumé, academic reference) should be submitted to the International Programs Office (IPO), B206 Mackintosh-Corry Hall by Friday 09 January 2015, by 4:30pm. Students should include their name and student number on all supporting documents. All components of the application must be submitted to the IPO by the deadline for consideration. If applicable, the Queen's University Exchange Bursary application form can be submitted to the Student Awards Office by CONFIRM WITH STUDENT AWARDS. General Information Student Number * Degree Program * Current Year of Study * - Select -1234 Faculty/School * Career * - Select -UndergraduateGraduate E-mail Address * Personal Information Title * - Select -MissMs.Mrs.Mr. Surname * Given Name * Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998 Country or Countries of Citizenship (countries from which you hold a valid passport) * First Language * My first language is English If not English, please specify: First Language If not English, please specify: Special Needs Students with special needs (including learning or physical disabilities, a health condition) may not be able to have their needs accommodated at each partner institution. Identifying a special need will be used for the sole purpose of matching students to the most appropriate partner institution. Special Needs Type - None -Physical disabilityLearning disabilityOther... Special Needs Type Other... Special Needs Details Multifaculty Exchange Preference All of the exchange programs listed below have special application requirements in addition to the Queen’s multifaculty application. Most of the programs (with the exception of the University of St Andrews) also require their own exchange program application form, which can be found on the program website. Applications for these exchange programs must be received by the deadlines listed below. Please return applications and all supporting documents to the International Programs Office (IPO), B206 Mackintosh-Corry Hall. Use the checkboxes to select the exchange program(s) for which an application will be submitted to the IPO. Killam Fellowships Program Deadline: 09 January 2015 Apply for the Killam Fellowships Exchange Program Application Requirements A completed cover sheet and checklist A completed, signed and dated Killam Fellowships Program application form (available at: http://www.killamfellowships.com) A personal statement [one (1) single-spaced page maximum] A clear and concise curriculum vitae/résumé (three (3) pages maximum) A course selection for the top three (3) choices for which you want to be considered, approved and signed by a student academic advisor at your home university Two (2) reference forms (forms are mandatory, letters are optional) in sealed envelopes with the signature of the referees on the seals. At least one reference should be from a university professor familiar with your work An official university transcript in a sealed envelope (see application instructions for more details) A photocopy of your passport (preferable), birth certificate, or other documentation that verifies citizenship A report on English language proficiency, if your first language is not English and you are not currently studying at an English-language institution Ontario/Baden-Württemberg (OBW) Deadline: 09 January 2015 Apply for the Ontario/Baden-Württemberg (OBW) Program Application Requirements Printed version of the OBW Application Form with your signature at the bottom of the page (available at: http://obw.ouinternational.ca/apply-0) Your “Statement of Motivation” This is an explanation of your reasons for wanting to participate in the exchange and what you hope to accomplish while on it. You should explain what makes you a good candidate and why you have chosen the universities you list on the application form. Your summary should be a maximum of one page in length and should bear the heading “Statement of Motivation” 1-page curriculum vitae (resumé) Official transcript(s) or certified lists of courses taken from all post-secondary institutions attended Two letters of support from faculty members who know you and your work well. At least one of these referees must be in your major field A language assessment form completed by a qualified German teacher A passport sized picture, taped or glued to the top right corner of the OBW Application Form. Please note that all qualified applicants will be required to complete an interview in German. Ontario/Maharashtra-Goa (OMG) Deadline: 09 January 2015 Apply for the Ontario/Maharashtra-Goa (OMG) Exchange Program Application Requirements Printed version of the OMG Application Form with your signature at the bottom of the page (available at: http://omg.ouinternational.ca/apply) Indicate one or more host universities (in order of preference). If you have especially good reasons to be at a specific university, please explain them in your "Statement of Study or Research" Your “Statement of Study or Research” Using no more than one page, state your reasons for wanting to participate in the OMG Program and your academic goals and interests for the term/year in Maharashtra/Goa. Indicate your reasons for choosing the host institution(s). The heading of the page should be "Statement of Study or Research." 1-page curriculum vitae (resumé) Please attach one-page CV to this application. Include information on your education, employment, volunteer work, hobbies and interests, skills and qualifications, as well as prizes, scholarships and awards. Official transcript(s) or certified lists of courses taken at all post-secondary institutions attended. Two letters of support from faculty members who know you and your work well. At least one of these referees must be in your major field. A digital passport quality photo - only needed in the pdf, not to be submitted in the paper application. Ontario/Rhône-Alpes (ORA) Deadline: 09 January 2015 Apply for the Ontario/Rhône-Alpes (ORA) Program Application Requirements Printed version of the application form with your signature at the bottom of the page (available at http://www.ora.ouinternational.ca/apply) Your “Study Proposal.” This is an explanation of your reasons for wanting to participate in the exchange and what you hope to accomplish while on it. What makes you a good candidate and why have you chosen the three universities you list on the ORA application form? Your summary should be a maximum of one page double space in length and should bear the heading “Study Proposal.” 1-page curriculum vitae (resumé) Official transcript(s) or certified lists of courses taken from all post-secondary institutions attended Two (2) Letters of support from university teachers who know you and your work well. At least one of these referees must be in your major field A language assessment form/test completed by the Queen's University Department of French Studies. A passport sized picture, taped or glued to the top-right corner of the ORA application form We do NOT require copies of your passport. Please do not include them in your package. University of St Andrews Deadline: 09 January 2015 Apply for the University of St Andrews Program Application Requirements An essay on how the life of Robert Tyre Jones, Jr. relates to your life, experiences and goals. The essay must be typed, double spaced and no longer than two pages in length Statement of interest in the form of a letter explaining why you wish to attend the University of St Andrews and the course of study you hope to take while there. The letter must contain your signature A copy of your current résumé Academic reference form, from a professor (or a TA, co-signed by a professor). The reference form is available on the IPO website. Selection Information A selection committee will adjudicate the applications and will, in cooperation with the Board of Trustees of the Canadian Robert T. Jones, Jr. Scholarship Foundation, select the winners. Golf skill is not a criterion for selection. Please note, if selected for an interview, you will be informed of the date and time for the interview. Consent: I authorize Queen's University to release my Queen's University academic record to the selection committee for the Canadian Robert T. Jones, Jr. Scholarship. If I am a successful candidate I authorize Queen's University to forward a copy of my full application to the Chair of the Canadian Robert T. Jones, Jr. Scholarship Foundation. I Consent Statement of Understanding I, the applicant, understand fully and clearly that, for all Queen's University Exchange programs, the following conditions apply: By the end of the preceding year of study, the student must have maintained the host university GPA admission requirement (or equivalent) and not be on academic probation (or a candidate for academic probation) up until the commencement of the academic exchange. Students participating in the academic exchange program are bound by the terms of the Queen’s University Student Code of Conduct prior to, during, and following the exchange period. In the event that the student violates the Student Code of Conduct, permission to participate in the academic exchange program may be revoked. While on exchange, students are subject to the rules and regulations of the partner institution and host country. Students are expected to return to Queen's University to complete their degrees after participating in the exchange. Tuition and ancillary fees (e.g. Student activity fees) are to be paid to Queen's University PRIOR to commencement of the exchange, subject to the established methods and payment deadlines as they would normally be paid if the student was not participating in an exchange. Students on exchange are exempt from paying tuition fees to the host university but may be required to pay additional fees (other than tuition), such as mandatory health insurance, activity fees, etc., to the host university. Students participating on an exchange will be responsible for all costs associated with transportation, books, health insurance, medical and personal expenses. It is the responsibility of the student to secure suitable accommodations as well as the costs thereof. Participation in an exchange does not guarantee enrolment in desired courses at the partner institution. Credit will be given only for Queen's-approved courses successfully completed at the partner institution. Students are responsible for obtaining the necessary immigration documentation as required. Please note that it may take up to 4 months to obtain such documentation. Students are responsible for ensuring that appropriate and sufficient health insurance is obtained to cover the period of time while on the exchange and while travelling to and from the host country. Specific requirements apply at some host institutions. Study on an exchange falls under Queen’s University’s Off-Campus Activity Safety Policy (OCASP). As such an undergraduate student must complete the mandatory OCASP Safety Planning Record (SPR) process from completion of the record which includes pre-departure orientation and registration in the Emergency Support Program (ESP), prior to the expected date of departure. If the student does not complete this mandatory requirement prior to departure, the SPR will not be approved. In the event that the Canadian Department of Foreign Affairs, Trade and Development (DFATD) (see www.voyage.gc.ca) issues a travel warning advising against travel to the location or region of the host university following the issuance of the International Letter of Permission (ILOP) by Queen’s, but prior to the student’s departure to the host university, the ILOP will automatically be rescinded. In this circumstance, to seek an exception the student must apply in writing, giving reasons for the request and documenting how the hazards identified in the DFATD warning can be mitigated. The ILOP will not be reinstated unless the student is able to demonstrate to the satisfaction of Queen’s University International Centre (QUIC) that the hazards identified in the DFATD warning can be mitigated appropriately. In the event that DFATD issues a travel warning advising against travel to or visits within the location or region of the intended host university after the student’s departure, under the OCASP the student is required to revise the OCASP Safety Planning Record (SPR) to reflect the new circumstances, and resubmit it to QUIC for review and approval. If the new hazards cannot be mitigated appropriately, Queen’s University may require the student to leave the area of risk. Failure to revise and resubmit the SPR and to cooperate with Queen’s University in managing the student’s risk may result in the student not being granted academic credit by Queen’s for the affected term of study. It is the student’s responsibility to decide whether to purchase travel cancellation insurance. Cancellation insurance may provide coverage in the event that travel plans are altered because of circumstances that lead to the issuance of a Travel Warning by DFATD. I authorize Queen's University to release my Queen's University academic record to the selection committee. I agree Privacy Information: The personal information on this form is collected under the authority of the Royal Charter of 1841, as amended. The information collected on this form may be retained in the student's file, will be used to process this request, and will be shared with Queen's personnel and personnel at the partner institution(s) identified by the student as desire partner institution(s) who need the information to perform their duties. If you have any questions about the information collected or how it will be used, please contact the Freedom of Information and Protection of Privacy Act ("FIPPA") Coordinator, Faculty of Arts and Science, Dunning Hall, First Floor, 94 University Avenue, 613-533-2470.