ANU EXCHANGE APPLICATION FORM
FOR 2016/17
To be completed by the student and returned along with full supporting documentation to: Study Abroad
Administrator, Examination Schools, 75 – 81 High Street, Oxford OX1 4BG by 12 noon on Friday 11 March
2016.
Please note incomplete or late applications will not be accepted. This form is for current students enrolled at
Oxford wishing to complete a period of study at ANU.
Title (tick one box only):
Mr
Mrs
Miss
Ms
Other
Surname:
First name(s):
Date of birth (dd/mm/yyyy):
Student number:
(4-6 digit number on student bod card)
Nationality:
College:
Residency:
(please confirm your country of ordinary residence prior to commencing your studies at Oxford)
Oxford email address:
Full correspondence address (term-time):
Full correspondence address (outside term-time):
Degree for which you are currently registered e.g. MPhil Development Studies:
Department or Faculty :
Start date of current programme of study:
Expected completion date:
(or date conferred)
Project or thesis title:
Proposed future career plans:
Please return this form, with the other application materials to the Study Abroad Administrator,
Examination Schools, 75-81 High Street, Oxford OX1 4BG by 12 noon on Friday 11th March 2016
DETAILS OF PROPOSED STUDY
Dates of proposed study (dd/mm/yyyy):
From:
To:
Have you already contacted ANU about your proposed study period:
Yes
No
If yes, please give the name and position of the person you have contacted and provide details of the outcome
of this contact:
What other sources of funding do you have for this study period?
Please give the name and contact details of two academic referees below.
Please note that you should obtain the letters of reference directly from your referees and attach them to your application.
Referee 1:
Referee 2:
Please return this form, with the other application materials to the Study Abroad Administrator,
Examination Schools, 75-81 High Street, Oxford OX1 4BG by 12 noon on Friday 11th March 2016
STATEMENT BY APPLICANT
Please state your reasons for wishing to study at ANU, provide an outline of the courses or research you
would undertake, and state how this will benefit your studies at Oxford (max 500 words).
Please note that this is not intended to be a detailed outline of your research interests and should be written in
language which can be understood by a non-specialist.
DECLARATION
I declare that the information I have given on all parts of this application form is correct and complete to the
best of my knowledge, and if information is knowingly incorrect my award could be revoked. I confirm that I
have sought approval from my tutor or supervisor to undertake this period of study abroad.
Signed (digital signatures not accepted):
Date:
Please print name:
Please return this form, with the other application materials to the Study Abroad Administrator,
Examination Schools, 75-81 High Street, Oxford OX1 4BG by 12 noon on Friday 11th March 2016