Application Form for Outbound Student Exchange

Applicant's Details
MM/DD/YYYY
School and Academic Information

Recommendation letters are optional to upload:
Current Contact Details
Emergency Contact Details
Additional Information
Please answer the following questions:
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Student Affidavit
I understand that submitting an application for the student exchange program does not guarantee acceptance into the program.

I understand that candidates must meet program requirements and be approved by the program's faculty advisor. I understand that participation is also subject to availability.

I further understand that the program may be cancelled due to low enrollment or other factors and I understand that I will be informed of such a decision no later than 6 weeks before planned departure date or as soon as possible after any adverse circumstances that cause the program to be cancelled.

I pledge to abide strictly by all rules and regulations of the host institution and to pay all costs associated with the program. I pledge to abide by the host’s Code of Student Conduct and to conduct myself according to the accepted Code of Academic Integrity.

I hereby authorize, officials at any educational institution that I have attended, to release my disciplinary records to the office of Student Exchange, to which I am applying. (Access includes, but is not limited to my records maintained by the Judicial Programs and Services Office, the Registrar, the Department of Housing, and/or the Office of the Vice President for Academic Affairs).
I fully understand that my disciplinary records may be a factor in evaluating my application.

I hereby confirm, I am aware the deadline for accepting or declining my spot in the frame of the student exchange program is at the latest TWO (2) WEEKS from receiving my acceptance letter.
I hereby undertake, failure to meet the deadline date, will result in a three hundred and fifty ($350) Dollars fine, which will be charged and collected by the tuition department and registered as a "penalty".

Please note, a letter of acceptance from Reichman University does NOT yet mean you have been accepted to the host university!

I further acknowledge that the information provided on this application is true and accurate to the best of my knowledge. I fully understand that providing false information during the application process may be grounds for rejecting my application or grounds for dismissal from the student exchange program.