Application Form for International Exchange Program Admission

This application is for students coming to Heidelberg University in the USA from our exchange programs with:

Universität Heidelberg, Germany
Miyagi Gakuin, Japan
Business Academy Aarhus, Denmark
Hanze University of Applied Sciences, the Netherlands
Heilongjiang International University, China
Tianjin Normal University, China
University of Ulsan, South Korea

Admission decisions are made approximately within two weeks of receipt of the requested documents.

Items with an (* ) are required.

Personal Information

First Name (Given Name): *

Middle Name:

Family Name (Surname): *

Preferred First Name:

Gender: *

Female

Male

Country of citizenship: *

Place of Birth: *

City and Country

Date of Birth: *

Month

Day

Year

Marital/Family Status

Marital Status *

Full name of husband or wife: *

If you come to this country, will any other member(s) of your family come with you? *

Yes

Please list their names and relationship to you: *

Contact Information

Preferred Telephone: *

Home

Cell

Home Telephone Number:

Cell Phone Number:

Email Address: *

Skype Account:

Permanent Home Address

Street: *

City: *

State/Province:

ZIP/Postal Code: *

Country: *

Is your mailing address different than your permanent address? *

Yes

Mailing Address

Street: *

City: *

State/Province:

ZIP/Postal Code: *

Country: *

Emergency Contacts

In the United States:

Full Name

Relationship to you:

Telephone Number:

Address

In your home country:

Full Name

Relationship to you:

Telephone Number:

Address

Visa Information

Have you ever been in the United States for educational purposes? *

Yes

On what date did you enter the U.S.? *

Month

Day

Year

Please indicate the type of visa you now hold: *

Names of institutions you have attended and/or are attending in the U.S.:

Why do you wish to attend Heidelberg University?

Family Information

Father

First Name:

Family Name:

Is your father's address different from yours? *

Yes

Mailing Address

Street: *

City: *

State/Province:

ZIP/Postal Code: *

Country: *

Father's Telephone Number:

Father's Email Address:

Father's Employer:

Position/Title:

Mother

First Name:

Family Name:

Is your mother's address different from yours? *

Yes

Mailing Address

Street: *

City: *

State/Province:

ZIP/Postal Code: *

Country: *

Mother's Telephone Number:

Mother's Email Address:

Mother's Employer:

Position/Title:

Educational Plans

Applying for enrollment as an Exchange Student beginning *

How long do you plan to study at Heidelberg? *

in the year *

Intended Major(s) and Minor(s)

First Major: *

Second Major:

Minor

Primary Instrument *

Pre-Professional and Cooperative Programs:

You can pursue a pre-professional or cooperative degree program via any undergraduate major offered at Heidelberg.

Pre-professional program:

Co-curricular/Sports Interests:

English Language Proficiency

All international students must be proficient in English to access full academic classes at Heidelberg.

I am proficient in English because *

I have passed a TOEFL exam

I have passed an IELTS exam

I have completed ELS Language Center Education

I wish to have a Skype interview to prove my English proficiency

I am NOT proficient in English and am planning to attend the Heidelberg English Language Institution (HELI) for ESL coursework before entering my academic program.

Other

Score *

Date *

Month

Day

Year

Explain any other circumstances about your English proficiency *

College or University Attending

Indicate the school you are currently attending.

School Name

Location (City, State, ZIP/Postal Code, Country)

Dates Attended

From

Month

Day

Year

Month

Day

Year

Other Required Information

Have you ever been found guilty of a misdemeanor, felony or other crime? *

Yes

Please explain, including the approximate date of the incident *

By clicking Submit (below), I affirm that the information presented in my application is complete and accurate to the best of my knowledge. I understand that any intentional omission or misrepresentation of information on this form could result in denial of admission or dismissal from Heidelberg University. I am aware that all transcripts submitted to Heidelberg in support of my application become the property of Heidelberg University.

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Application Form for International Exchange Program Admission