National Student Exchange
Undergraduate Application
East Tennessee State University
Application Deadline: February 15th
Deadline for priority placement is February 1st
(For placements during next academic year)
Please submit with the attached application:
1.
Non-refundable application fee: $150
(make check payable to: ETSU International Programs and Services)
2.
3.
4.
5.
Unofficial transcript (2.5 GPA required)
One (1) Recommendation form from a Faculty
Member
Statement of personal goals and reasons for
exchange participation
Language proficiency report, if appropriate
National Student Exchange Policies
The National Student Exchange is a program designed to provide the opportunity for you to attend a
college or university in another state without having to pay the high cost of out-of-state tuition. Payment
for tuition is made in one of two ways. Using the NSE Plan A, you are registered at East Tennessee
State University but are not assessed ETSU tuition and fees. Your tuition and fees are paid at the host
campus as if you were a resident of the state in which the host campus is located. Using the NSE Plan B,
you are registered and pay your tuition and fees at ETSU, but will NOT pay tuition or fees at the host
campuses. With either plan, room and board are your financial responsibility and are paid to the host
campus.
ETSU students who participate in the NSE remain as degree-seeking, registered students at ETSU. Any
financial aid that is normally available can be applied to the exchange obligations. Because NSE is an
officially approved program of the university, all courses with their respective credit hours and earned
grades will be recorded on the ETSU transcript and be calculated in the GPA. Students must, however,
complete a course transfer agreement form before departing for the exchange.
To be eligible for participation in the exchange you must be a full-time student at ETSU and in good
standing socially, financially, and academically, with an earned grade point average of at least 2.50.
Acceptance into the program will be determined as a result of an evaluation of a fully completed
application.
While on exchange, you remain an enrolled student at ETSU, but subject to the rules and regulations of
your host campus. ETSU may withdraw your exchange privileges if your behavior or academic
performance leads to a probation status at the host campus, or would have led to any judicial action if you
had remained at ETSU.
East Tennessee State University
International Programs and Services
122 Yoakley HALL
Telephone: (423) 439-7737
E-Mail: interntl@etsu.edu
NSE Application and Placement Procedures
The following application procedures will direct you through the process that is used at ETSU to ensure
that NSE is both appropriate and beneficial for you.
1. Visit International Programs and Services, 122 Yoakley Hall, to obtain information about the program.
The information should include the NSE brochure, Directory of Exchange Opportunities, which describes
the National Student Exchange Program and provides a thumbnail sketch of each of the member colleges
and universities and the majors offered at those schools, along with the special opportunities available to
incoming NSE students.
2. Read the Directory of Exchange Opportunities while paying particular attention to the beginning
sections that describe the overall process of exchange and how to efficiently use the brochure. As you
read, you should think in terms of your personal and academic goals and objectives.
3. We suggest that you write your exchange goals and objectives on paper. Include both personal and
academic goals.
4. Discuss your plans with your academic advisor, parents, friends, and the International Programs and
Services staff.
5.
Read the entire application prior to providing the information requested.
6.
Carefully complete the application following the directions exactly.
7. The processing of your application is the responsibility of ETSU. Once it is determined that you are
eligible to participate, the potential exchange campuses consider you based only on available space.
Most placement decisions are made at a national conference that is held in mid-March and include
placements for the spring semester as well as the fall or full academic year.
8. Immediately following the placement conference, you will be notified of your placement and asked to
sign a placement acceptance form that will be mailed to your host campus.
9. You will then receive information regarding housing, meal plans, tuition, registration, and any other
information you will need to know, directly from the host institution.
10. You will complete an advising agreement with the help of your academic advisor. It will be your
guarantee that the courses you take while on exchange will fit into your ETSU academic program.
11. Soon you will be attending your new campus, making new friends, and seeing new places. When
you arrive, we ask that you send us a postcard with your address and telephone number. It is important
that we know how to contact you in an emergency situation.
12. At the end of your exchange, it is your responsibility to request a transcript to be sent from the host
institution directly to ETSU, International Programs and Services, Attn.: Kelly Hill, P.O. Box 70668,
Johnson City, TN. 37614-1701.
Application For Exchange
Deadline for Priority Placement: February 1st
Application Deadline: February 15th
Date Application Submitted: ___________
Nonrefundable Application Fee Received: _________
The application is not considered complete until the fee has been paid.
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Please type or print very clearly.i
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Return This Form To:
East Tennessee State University
International Programs and Services
Box 70668
122 Yoakley Hall
Johnson City, TN 37614
CONTACT INFORMATION
Name: First
Middle:
i
s
Last:
Current Address:
n
o
t
Street/Residence Hall and Room
City:
State/Province:
Zip/Postal Code:
Permanent Address:
Street:
City:
State/Province:
Current Phone Number with Area Code:
Zip/Postal Code:
Extension:
Permanent Phone Number with Area Code:
Alternate Phone with Area Code:
Goldmail E-mail :
Alternate E-mail :
c
o
m
p
l
e
t
e
E- Number:
DEMOGRAPHIC INFORMATION
Date of Birth (mm/dd/yyyy):
Gender: Male
Are you currently living in on-campus housing? Yes
Female
No
Are you a resident of the state/province in which your home campus is located? Yes
Country of Citizenship: United States
Non-resident alien
Canada
No
Other:
- If non-resident alien, visa type
c
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s
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d
Resident alien
DEMOGRAPHIC INFORMATION, continued
Primary reason(s) for exchange – check all applicable
access different courses/faculty
enter host campus honors program
evaluate graduate schools
exchange as a resident assistant
live in a different area
language study
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personal growth
participate in host campus international program
look for future employment
other:
SCHOLASTIC AND OTHER INFORMATION
Current Class Level: Fr
So
Jr
Sr
Cumulative grade point average:
Major:
Minor:
Will you need courses in your major while on exchange? Yes
No
Are you requesting financial aid (Plan A) from the host campus? Yes
Are your currently receiving financial aid? Yes
No
No
Where do you plan to reside at the exchange school? Residence Hall
Off-campus
Are you currently enrolled in the honors program? Yes
Marital Status: Single
Married
No
Will you be accompanied on exchange by spouse? Yes
No
Do you wish to go on exchange with another student? Yes
If yes, name of the student(s):
Name of campus at which the student(s) is enrolled:
EXCHANGE REQUESTS
Period of requested exchange:
Sorority/Fraternity
No
Fall Semester 20
Fall Quarter 20
Spring Quarter 20
Spring Semester 20
Winter Quarter 20
Summer 20
List in priority the institutions you wish to attend and the tuition payment plan(s) you could use. (Use an
additional sheet if more than five institutions are requested.)
Name of Institution
Tuition Payment Plan
Plan A=In-state tuition/fees are paid to host institution.
Plan B=You pay your normal tuition fees to your home campus
1.
A only
B only
A or B prefer
2.
A only
B only
A or B prefer
3.
A only
B only
A or B prefer
4.
A only
B only
A or B prefer
5.
A only
B only
A or B prefer
EDUCATIONAL BACKGROUND
Number of credits completed to date:
Number of credits enrolled in current term:
Expected graduation date:
Do you have any incomplete grades, missing grades, or other deficiencies (e.g. failure to complete
required proficiency tests)? Yes
No
If yes, please explain:
Activities, positions, honors while in college:
SPECIAL NEEDS OR CIRCUMSTANCES
If you have a physical condition for which accessible, on-campus housing or classroom accommodation
might be needed; a documented disability which may require academic accommodation (e.g., note
takers, taped texts); a medical condition which might require immediate attention during exchange; or a
condition which might affect emotional or mental well-being during exchange, you are encouraged to
identify your needs by attaching a separate page indicating the nature and extent of your circumstances
and arrangements which are currently being made for you on this campus. Also indicate whether or not
we may contact your requested host campuses at this time. NSE does not discriminate on the basis of
special needs. Rather, your disclosure at this stage of the application process is invited in order to assist
you in identifying a placement site which can provide reasonable accommodation of your needs.
Following placement, it is your responsibility to consult the host campus coordinator and ADA officer to
determine the deadlines by which you must submit written, current, and professionally documented
information as required by your host campus.
OTHER CONSIDERATIONS
Have you ever been convicted of a felony? Yes
No
Are you on probation, parole, or have any legal judgments pending against you either inside or outside of
campus? Yes
No
If yes, please explain:
Are you currently under any campus disciplinary action for violation of codes of academic or student
conduct? Yes
No
If yes, please explain:
Do you have any outstanding indebtedness to the campus? Yes
LANGUAGE PROFICIENCY
What is your native language? English
French
Spanish
No
Other
If you plan to exchange to a campus in Puerto Rico, you must be certified for proficiency in Spanish. If
you plan to exchange to the University de Sherbrooke in Quebec, you must be certified for proficiency in
French. If English is not your first language, for all other NSE locations you must demonstrate proficiency
in English. Language proficiency must be determined prior to placement.
RECOMMENDATION/REFERENCE
Submit reference for at least one faculty member who will recommend you for exchange.
. Faculty/Staff name:
Department/Office:
Phone:
EMERGENCY CONTACT
Name:
Relationship:
Street:
City:
Phone Number with Area Code:
State/Province:
E-mail:
Zip/Postal Code:
RELEASE OF INFORMATION
The collection, retention, and dissemination of your records and information about you are subject to
federal regulation under the Family Education Rights and Privacy Act of 1974. You are responsible for
specifying the persons or agents who have access to your records. Therefore, it is necessary that we
obtain your permission to request and release information pertinent to your exchange. Please read the
following statements and sign below:
 I understand that it will be necessary for my campus to obtain certain information about my academic
and non-academic record in order to: 1) ascertain my eligibility and suitability for an exchange
through NSE, and 2) facilitate my exchange after it is arranged. I hereby grant permission to the NSE
coordinator and/or designee to obtain information that is appropriate to my application and
participation in the exchange including, but not limited to, letters of recommendation, permanent
academic records and transcripts, conduct, fiscal records, medical records, all for the purposes of
exchange placement and participation, continuation, or termination.
 I give permission to the NSE coordinator and/or designee to contact appropriate personnel in order to
verify that I am under no disciplinary action for violation of codes of academic and student conduct
and/or that I have no judicial cases pending which would invalidate my eligibility for exchange.
 I hereby release information contained in my application, letters of recommendation, transcripts, and
other information required as part of the NSE application process to my home NSE Coordinator,
designee, and those individuals/committees responsible for reviewing and approving my application for
exchange participation.
 I hereby release information contained in my application, letters of recommendation, transcripts, and
other information required as part of the NSE application process to the National Student Exchange
Central Office and to the NSE host institution at which I am placed.
Signature:
Date:
SUPPORTING MATERIALS OR OTHER REQUIREMENTS
unofficial transcript (print off Goldlink)
recommendation/reference
statement of personal goals and reasons for exchange participation (Attach short essay)
application fee ($150)
SIGNATURE
I have read and fully understand:
 information on eligibility, policy, and procedures presented on www.nse.org
 campus policies and procedures governing my exchange participation
I further understand that:
 participating in the National Student Exchange is a privilege and not a right
 I must, at all times prior to and during my exchange, meet the eligibility requirements
(academic, behavioral, and financial) of the program and those of my home and host
campuses, and that failure to do so will result in the cancellation of my exchange.
If accepted for participation in the National Student Exchange, I agree to adhere to all the rules and
regulations of both my home and host institutions. Failure to do so will result in the cancellation of my
exchange.
I affirm that all information is complete, accurate, and true to the best of my knowledge. I acknowledge
that I am signing freely, voluntarily, and under no compulsion.
Signature:
Date:
Reference –Faculty
Member
APPLICANT: PLEASE COMPLETE THIS SECTION
Applicant’s Name:
In compliance with the Family Education Rights and Privacy Act of 1974, the candidate may have access
to this evaluation unless access is waived by completing the following statement:
I,
, waive my right to access this evaluation.
Signature:
Date:
TO THE EVALUATOR:
The National Student Exchange (NSE) provides students with the opportunity to attend another member
university within the United States, its territories, and Canada for up to one year. Students participate in
NSE to take advantage of the unique geographic, cultural, and academic characteristics of the institution
and region.
In making decisions on the appropriateness of a student's participation in the exchange, we need to know
about their motivation, adaptability, academic skills, and those personal qualities that will give students
the ability to benefit fully from the exchange experience. While we will appreciate any observations that
will assist us in evaluating the present applicant, of special interest are qualities such as competence,
independence, assertiveness, resourcefulness, quality of performance, confidence, social skills, openmindedness, and integrity.
Please indicate the basis and extent of your acquaintance with the applicant. Placing your remarks in a
comparative perspective will further assist the NSE office in reaching a decision about the applicant.
In summation, please state frankly your opinion of this applicant's chances for academic and nonacademic success in an exchange program, weighing both strong and weak points.
1. How well do you know the applicant? (Check the most appropriate response.)
Extensive contact in a variety of settings
Well acquainted in classroom or campus environment
Limited contact in classroom or campus environment
Other:
2. In comparison with other students whom you have known at comparable stages of their
education, please rate the applicant in these areas. (Circle the most appropriate response.)
Unable
Below
to
Excellent Very Good
Average
Average
Judge
Academic Ability
4
3
2
1
X
Maturity
4
3
2
1
X
Cooperation & Adaptability 4
3
2
1
X
Initiative & Motivation
4
3
2
1
X
Social Skills
4
3
2
1
X
Open-mindedness
4
3
2
1
X
Integrity
4
3
2
1
X
Independence
4
3
2
1
X
Resourcefulness
4
3
2
1
X
Self-Confidence
4
3
2
1
X
3. Exchange to another campus would be appropriate for the applicant: Yes
No
4. Remarks
Based on your knowledge of the applicant, please comment on his/her chances for success
and what would be gained from an exchange experience.
Faculty/Staff
Parent
Other
Name:
Phone Number with Area Code:
E-mail:
Signature:
Date:
Return this form to:
East Tennessee State University
International Programs and Services
Box 70668
122 Yoakley Hall
Johnson City, TN 37614