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bm01 Hsu Application Form For Outbound Student-220921

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bm01 Hsu Application Form For Outbound Student-220921

Uploaded by

tri.nq05940
4 views2 pages

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bm01_hsu_application_form_for_outbound_student-220921

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Copyright:

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4 views2 pages

bm01 Hsu Application Form For Outbound Student-220921

Uploaded by

tri.nq05940

Copyright:

© All Rights Reserved
Download as DOCX, PDF, TXT or read online from Scribd
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You are on page 1/ 2

For office use only

Date of submission: ____/____/20____


Priority set (if any):  

STUDENT MOBILITY PROGRAM


APPLICATION FORM Passport photo
For Outbound Students 4cm x 6cm

Press arrow keys     to switch between boxes.

1 – Student contact
information

Family Name: Họ (gõ dấu) Date of birth: Click here to enter a date.
Middle Name: Lót (gõ dấu) Gender: ...
Given Name: Tên (gõ dấu) Nationality:
Passport No.: Date of expiry (Passport): Click here to enter a date.
Identity Card No.: Date of issue (ID card): Click here to enter a date.
Permanent Address: Number, Tower, Street, Ward, District, City, Vietnam
Home Phone: Mobile phone:
Student Email: @sinhvien.hoasen.edu.vn
Personal Email:
Facebook (email):

2 – Student information at Hoa Sen University

Student ID No.: Year of Admission: Class:


Faculty: Major:
Language Competency: English Level: (minimum IELTS academic 5.5/ TOEFL
iBT 70)
Other: Level:

3 – Proposed exchange or study abroad plan and courses

Host Institution:
Study program at host institution:
Study Duration:
Commencement: Year of commencement:

Page 1
Scholarship, if any: Not this time If YES, the Scholarship title is
Contact in case of EMERGENCY

Full Name: HỌ TÊN (GÕ DẤU) Relationship with student:


Address: Number, Tower, Street, Ward, District, City, Vietnam
Phone: Personal Email:

4 - Declaration
1. I, undersign, hereby declare that, to the best of my knowledge and belief, the information
provided on this application is complete and accurate. I understand that any discrepancies
in these details may result in cancelling my enrolment.
2. I authorize Hoa Sen University to obtain official student records from any education
institution necessary to make an informed decision about my application or matters
relating to enrolment.
3. I will complete the Admission required by the host institution as instructed.
4. In an emergency, I hereby grant Hoa Sen University staff the authority to contact the
nominated emergency contact on my behalf.
5. I understand that Hoa Sen University may pass my name and email address to Hoa Sen
students for promoting the exchange/mobility program. In addition, I am willing to share
experience, pictures and testimonials upon my return.
6. I understand that Hoa Sen University has no responsibility for my financial support. I take
responsibility to book my own temporary and permanent accommodation. I understand if
looking for off-campus accommodation that it is recommended I arrive in the host country
at least 3 weeks prior to commencement of the semester.
7. I understand that I must follow the rules, regulations and obligation by laws of both
Vietnam and the host country. I also confirm to return Vietnam at most a month after my
mobility program and complete the rest of my study program at Hoa Sen University. Any
misconduct will result in cancellation of my university following by disciplinary.
8. I must keep contact with the Mobility Program Coordinator during my study at the host
institution at least once a month via email, Facebook or Skype etc.
9. In case of cancellation of this application, I must inform the Mobility Program Coordinator
in paper with supported documents for further arrangement.
10. I hereby submit this application for the exchange program and have attached the following
compulsory materials:

Passport photo
Photocopy of Birth Certificate
Photocopy of current Passport
Photocopy of the Confirmation of Student Mobility Course Registration
Photocopy of the Student Mobility Tuition Receipt
Foreign Language Proficiency Certificate
Course Equivalency Petition – Granted

Date of signature: Click here to enter a date.

Parent’s Signature Student’s Signature

Full name: Full name:


1. Fill in the form, print out the form, sign off
2. Submit completed application form to: Institute of Education & Global Engagement, Room 803, 8 Nguyen
Van Trang St., District 1

Page 2

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