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Application for USP Exchange

All sections must be completed. Only complete applications will be


processed.
Student Details
Student ID:

_________________________________________

Title:
Family name as in passport:

_________________________________________

Given names as in passport:

_________________________________________

Date of Birth:

_________________________________________

Country of Citizenship:

_________________________________________

Passport Number:

_________________________________________

Please attach a professional looking


passport size photograph of yourself:

Copy and Paste your pic in the above


box.

Contact details
Are you residing on campus?

Yes

No

Residential address in home country:

___________________________________
_
____
_

Mailing address [if different]:

___________________________________
_
____
_

Telephone:

_________________________________________

Mobile:

_________________________________________

Student email:

_________________________________________

Personal email:

_________________________________________

Emergency contact person:

_________________________________________

Relation to applicant:

_________________________________________

Emergency contact phone:

_________________________________________

USP Enrolment Details


Programme:

_________________________________________

Campus:

_________________________________________

Course level: Undergraduate


Courses currently enrolled in:

Study mode:
Sponsored?
IELT score [if applicable]

___________________________________
_
____
_
Fulltime
Yes

Distance
Learning
No

_________________________________________

Travel and Language Experience


Have you travelled overseas before?

Yes

No

Have you studied/worked overseas


before?
Do you speak a language[s] other than
English? Please specify

Yes

No

___________________________________
_
____
_

Overseas study plan


Required: Attach a personal statement explaining why you wish to participate and
why you would be a good ambassador for USP [1 A4 page only]
Which semester are you applying for?

_________________________________________

Nominate your institution preference: find USPs exchange partners click here.

Overseas university

Country

Preference 1
Preference 2
To complete the table below
1. Download unit descriptions from the host universitys website
2. Nominate at least 5 units per semester in the table below
3. Make an appointment to see your course coordinator for cross credit approval
Host University Units

USP equivalent

Unit code

Unit code

Unit title

Approval
Unit title

Extra-curricular activities
List your extra-curricular activities:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Student Declaration

I agree that the units approved will be the units taken while abroad. I
acknowledge that if units nominated proved to be unavailable or unsuitable it
is my responsibility to notify my course coordinators and obtain approval for
any changes made to my overseas study plan.

I declare that all the information I have supplied is complete and correct. I
acknowledge that provision of incorrect information or documentation may
result in cancellation of my application.

Student s Signature:

_________________________________________

Date:

_________________________________________

Required:
A personal reference click here to download.
An academic reference click here to download.

Submit in person to:

Post to:

Email to:

USP International

USP International

ella.bennion@usp.ac.fj

Celt Building

Laucala campus

Laucala campus

Suva
Fiji

Contact
USP International
Ph: 679 3232635
Web:
www.international.usp.ac.f
j