NEW YORK UNIVERSITY

International Exchange
www .nyu.edu/studyabroad/ex change
STUDENT DATA FORM
Along with this form, please submit the country specific application, a personal statement, NYU transcript and
two letters of recommendation from NYU faculty. Be sure to meet with your academic advisor to discuss your interest
and obtain clearance to apply. Once admitted by the partner university, we will send you an admissions packet to prepare
you for your semester(s) abroad. The International Exchange program is open to NYU students only.

SEMESTER FALL SPRING ACADEMIC YEAR

(year) (year)

PARTNER UNIVERSITY OF CHOICE:

PERSONAL INFORMATION
NYU COLLEGE AT WHICH YOU ARE CURRENTLY ENROLLED

EXPECTED DATE OF GRADUATION (M/Y) MAJOR GPA

NAME
Last—Family First Middle
OTHER NAMES THAT MAY APPEAR ON CREDENTIALS NYU ID:
DATE OF BIRTH (M/D/Y) GENDER Male Female

PERMANENT ADDRESS
Street/City/State/Zip Code
EMERGENCY CONTACT (name, phone, email)

CURRENT MAILING ADDRESS CURRENT INFORMATION VALID UNTIL

CURRENT TELEPHONE E-MAIL ADDRESS

CITIZENSHIP STATUS

U.S. Citizen Permanent Resident - Alien Registration Number: ______________ Refugee Other (country of citizenship): ___________

If "Other," are you currently in the United States? Yes No If "Yes," indicate visa/status.

IS ENGLISH YOUR NATIVE LANGUAGE? Yes No If "No," indicate your primary language.

MY SIGNATURE BELOW CERTIFIES THAT ALL INFORMATION PROVIDED ABOVE IS COMPLETE AND CORRECT.

SIGNATURE DATE (M/D/Y)

PERSONAL STATEMENT
On a separate sheet of paper, please write a 1-2 page detailed proposal explaining your educational and personal reasons
for choosing an International Exchange. Please be sure to include your name and NYU ID number.
Include any information you think would be of interest to the partner university admissions committee and answer
the following questions: Have you ever traveled in another country? Why is participating in an exchange program
important to you? How would this program complement your academic experience to date? What are your
expectations for personal growth through International Exchange?

Please return completed form to the NYU Office of Global Programs, 110 East 14th St., Lower Level, New York, NY 10003.