Exchange Student Application Form

Address & Contact Details

Email Address

Home Phone

Cellular/Mobile Phone

Permanent Address

Country

Street

City

Region

Postal Code

Is this also your Mailing Address?

Yes

No, I have a different mailing address

Mailing Address

Country

Street

City

Region

Postal Code

Emergency Contact

Relationship to you

First (Given) Name

Last (Family) Name

Telephone

Is this person's mailing address the same as yours?

Yes

Country

Street

City

Region

Postal Code

Special Needs

Do you have any special needs or require special services during your program (i.e., dietary considerations, learning aids, or facilities with handicapped access)?

Yes

Academic Information

Current major at home university:

Minor:

Completion Date:

List academic courses in progress:

Have you taken either the TOEFL or IELTS English language proficiency exam?

Yes

English is my primary language

Please arrange for a copy of your TOEFL/IELTS exam score report to be emailed to admission@rollins.edu or mailed to the address at the top of this form.

When do you expect to take the exam?

Required Essay

Please answer the following question: Why Rollins?

Your Home University Exchange Coordinator

Please provide the following details for the Exchange Coordinator at your institution. It is very important that this information is accurate as it will be used to obtain the required letter of recommendation in support of your application.

First (Given) Name

Last (Family) Name

Acknowledgements and Electronic Signature

I authorize the coordinator at my home institution to send my official academic records/transcripts to Rollins College.

I understand that official academic records/transcripts of coursework that I undertake at Rollins College will be sent by the Rollins College Registrar's Office to the coordinator at my home university.

I acknowledge that all statements in this application are complete and accurate to the best of my ability. By checking this box and typing my name below, I am electronically signing my application.

Electronic Signature (Please type your full name)

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