University Mailing Address (we will send your official transcript to this address, please confirm all the details before
APPLICATION FORM Personal Information First name
Last name
Digital Picture
Nationality Place of birth Date of birth _____/_____/_____ mm / dd / yy Age
Gender M
Passport / ID Number F
Home mailing address
Student’s e-mail address Student’s phone number
Country
Zip code
Home phone number
Emergency contact name
Email Phone
University of Origen (if applicable) Are you coming to ULACIT as part of a student exchange agreement our university holds with your home school? Yes No University Mailing Address (we will send your official transcript to this address, please confirm all the details before submitting this form)
Country
Major (if applicable)
Phone number Zip code Academic Advisor’s Name and signature
Academic Advisor’s Email Academic Advisor’s Phone School Term at ULACIT (specify dates)
Application Form
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APPLICATION FORM Declaration of Consent I certify that the information given in this application and the documents provided are correct and complete to the best of my knowledge and belief. I understand that any discrepancies in these details may result in my enrollment being cancelled. Yes I have taken notice that information on this form will be stored electronically and used by the international office in accordance with the provisions of the Costa Rican data privacy regulation laws. Yes I agree that my name and email address can be forwarded to students for the purposes of promoting the exchange program. Yes No I hereby confirm that I will comply with the laws of my host country. Yes I hereby confirm that I will comply with the rules and regulations of the hosting institution. Yes I hereby confirm that I will obtain the international insurance coverage before my experience abroad. Yes
Note: Please send this form thoroughly filled out to:
[email protected] The information in this document may be verified at any moment during the enrollment process. Illegible forms will be sent back. We advise applicants to have all the requested information handy as this form cannot be saved (this form is expected to be sent in PDF format). Please print it and sign it. Please attach the following documents to this form: Passport-sized digital picture Passport main page Scanned version of original grade transcript English proficiency certification, for non-English native speakers (IELTS, TOEFL). You can alsorequest an English language proficiency certification from your language school. On-line Spanish test results (this is an institutional requirement whether or not the student takes Spanish-taught courses). See instructions below: Please access the following link and take a screenshot of your results once you are finished with the test (just saying the result obtained will not be accepted). http://ave.cervantes.es/ prueba_nivel/registro/test_de_clasificacion.php?origen=webAVE
Student’s signature: _______________________________ Advisor’s signature: ________________________________
Application Form
Date (mm/dd/yy):__________________ Date (mm/dd/yy): __________________
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