UCONN administered State to State Program
BW-Germany Exchange Program
Yale University Student Application Checklist
Upon completing the Yale Study Abroad Office Application, please fill out and submit the following:

Personal Data Form

2 Faculty Recommendations

Conditions of Acceptance Form



Risk Form
This form must be notarized by a Notary Public or by your bank.
Mail the original copy to
BW-Germany Exchange Program
University of Connecticut
368 Fairfield Way, Room 116C, Unit 4207
Storrs, CT 06269-4207
2 Passport Photos
These are needed for your German University Application.
Official Transcript
Request that a copy must be sent to
BW-Germany Exchange Program
University of Connecticut
368 Fairfield Way, Room 116C, Unit 4207
Storrs, CT 06269-4207
With the exception of the Risk Form (which must be mailed to us), you may email all other forms to
germany@uconn.edu As soon as your file is complete, we will help you apply to your chosen German university.
BW-Germany Exchange Program
Yale University Student Personal Data Form
Name __________________________________________________________________________________
Date of Birth _________________________________
Place of Birth _____________________________
Country of Citizenship _________________________
Permanent Address _______________________________________________________________________
Email Address _______________________________
Phone (home) _______________________________
Phone (cell) ______________________________
Home University _________________________________________________________________________
University Address ________________________________________________________________________
Major (s) ___________________________________
Minor ___________________________________
Expected Date of Graduation ___________________
Father’s Name ___________________________________________________________________________
Address ________________________________________________________________________________
Phone (h) __________________________________
Phone (w) _______________________________
Mother’s Name __________________________________________________________________________
Address ________________________________________________________________________________
Phone (h) ___________________________________
Phone (w) _______________________________
Emergency Contact Name _____________________________
Relation to Contact ________________
Address ________________________________________________________________________________
Phone (h) ___________________________________
Phone (w) _______________________________
Fax ________________________________________
Email ___________________________________
Emergency Contact Name _____________________________
Relation to Contact ________________
Address ________________________________________________________________________________
Phone (h) ___________________________________
Phone (w) _______________________________
Fax ________________________________________
Email ___________________________________
ACADEMIC STANDING: Freshman _____ Sophomore _____ Junior _____ Senior _____ Graduate_____
Cumulative GPA _____
BW-Germany Exchange Program
Faculty Recommendation Form
Applicant Name __________________________________________________________________________
Instructions
The student named above has applied for admission to the BW-Germany Exchange Program. We would
appreciate your frank appraisal of this applicant’s abilities and potential. The letter should state the extent of
your acquaintance with the applicant, and your opinion of the applicant’s aptitude for study in a foreign setting.
Please attach additional sheets if needed.
Please return this form to:
BW-Germany Exchange Program
University of Connecticut
368 Fairfield Way, Room 116C, Unit 4207
Storrs, CT 06269-4207
Name (please type or print) _________________________________________________________________
Title ___________________________________________________________________________________
Address ________________________________________________________________________________
Signature
Date
BW-Germany Exchange Program
Faculty Recommendation Form
Applicant Name __________________________________________________________________________
Instructions
The student named above has applied for admission to the BW-Germany Exchange Program. We would
appreciate your frank appraisal of this applicant’s abilities and potential. The letter should state the extent of
your acquaintance with the applicant, and your opinion of the applicant’s aptitude for study in a foreign setting.
Please attach additional sheets if needed.
Please return this form to:
BW-Germany Exchange Program
University of Connecticut
368 Fairfield Way, Room 116C, Unit 4207
Storrs, CT 06269-4207
Name (please type or print) _________________________________________________________________
Title ___________________________________________________________________________________
Address ________________________________________________________________________________
Signature
Date
BW-Germany Exchange Program
Conditions of Acceptance
It is important to understand your privileges and responsibilities as a participant in the BW-Germany
Exchange Program. When you accept enrollment at another university, you are normally entitled to all the
privileges accorded to regular students, and you are expected to honor your host institution’s academic and
social conduct regulations. What may not be obvious is that when you accept placement in a reciprocal
exchange program such as the BW-Germany Exchange Program, you assume special obligations towards
the student with whom you are trading places. To avoid any and all misunderstandings, the conditions of your
acceptance of placement are listed below. Please read them carefully.
By accepting placement in the BW-Germany Exchange Program, I agree that:

I will take part in all aspects of the program.

I will pay all expenses required for participation in the program to my home and my host institution in a
timely fashion.

I will purchase insurance coverage as required.

I will have the status of non-degree student at my host institution.

My placement will be limited to the 20 -20
academic year. If I want to extend my stay, I must make
proper arrangements with my home and host institution.

My placement may be terminated at any time if I fail to remain enrolled full-time, do not meet the minimum
academic standards required by my host institution, or violate the student conduct code in effect at my
host institution.

My placement may be terminated at any time if I violate the laws or regulations of my host country.

If I withdraw from the program anytime after accepting the placement, or if my exchange placement is
terminated after I accept placement at my host institution:
1. I am subject to the withdrawal policy of my home institution with respect to notification deadlines,
financial obligations, and academic policy.
2. I am still responsible for all expenses to my host institution for the semester in which I withdrew (room
and board, insurance and other fees).
3. I must reimburse my host institution for any money advanced to me.
Name (please type or print) _________________________________________________________________
Signature
Date
BW-Germany Exchange Program
Risk Form
I, ____________________________, (student) voluntarily agree to participate in the BW-Germany Exchange
Program coordinated by the University of Connecticut.
I have been advised and am aware of the inherent and/or latent danger (including but not limited to risk
of serious injury, the hazards of travel, accident or illness, or acts of God) of participating in such
activity. I am aware and have been advised to have a medical examination prior to participating in this
activity to insure that I am in good physical health. Further, I am aware and have been advised that I
should see that I am properly covered by adequate accident and medical insurance for the entire
duration of my sojourn in Germany. (Note: The health insurance that you will purchase at your German
university will not be in effect until you register at your German university and will end at the end of the
German academic year).
I understand that this is a group program and that group standards must be observed. I agree that the University
of Connecticut and/or the coordinator of the program shall have the right at its/his/her discretion to terminate
my enrollment for failure to maintain these standards, or for actions or conduct which the University of
Connecticut and/or coordinator considers to be detrimental to or incompatible with the interest, harmony,
comfort or welfare of the program and group as a whole. I understand that the University of Connecticut and/or
coordinator reserve the right to change assignments and to make alterations in the program at any time without
prior notice if circumstances warrant.
I have and do hereby note, understand, and assume all risks which may rise from or in connection with this
activity. The terms hereof shall serve as a release and assumption of risk for my heirs, executors, assigns and
administrators and for all members of my family, including minors.
Student Signature ___________________________________________
Date ____________________
Address
_______________________________________________________________________________________
_______________________________________________________________________________________
Date of Birth _____________________________________________________________________________
Notarization_______________________________ (student’s name) personally appeared before me, and by
me known, and swore or affirmed that she/he freely and without reservation signed this release form.
Notarized by ________________________
Date ___________________________