Application Deadlines Fall semester or full year: May 1 Spring semester: November 1 STUDENT APPLICATION FORM EXCHANGE/STUDY ABROAD STUDENTS ACADEMIC YEAR 2015/2016 1. Personal details Family name: First name(s): Date of birth (DD/MM/YYYY): Place of birth: Citizenship: Gender (F/M): Address: Tel: E-mail: Contact person in case of emergency: Tel: E-mail: ATTACHMENT: PLEASE NOTE THAT IT IS MANDATORY TO ATTACH A TRANSCRIPT OF RECORDS FROM YOUR CURRENT EDUCATION 2. Education details Home Institution: Exchange program (Erasmus/EEA/ISEP/other): Period of Exchange: Area of Study: From: Name of contact person at home institution: Email of contact person: Page 1 of 4 To: 3. Academic work in progress Academic work in progress Please indicate academic work/courses in progress during the present academic year (list specific courses if applicable; use additional sheet if necessary) COURSE NAME: CREDITS/ECTS: 4. Language Proficiency Please note that no official English testing is necessary, only self-evaluation – see below: I am proficient in English language at least at B2 level (Europass, language assessment – see the definition of B2 level on the last page) Yes No Indicate here if you have taken an official test of English proficiency, such as TOEFL or IELTS and the score: 5. Campus When you make your choice, please be aware that you cannot select cross-campus courses or programmes! More information at www.hbv.no/english Please indicate which campus you plan to study at: Vestfold Hønefoss Drammen Kongsberg 6. List of courses you intend to take at HBV Please note that you are expected to take a minimum of 30 ECTS per semester. To view the full list of courses, click www.hbv.no/english COURSE NAME: ECTS: Please note: If you are planning a final project/thesis on HBV as an exchange student, it is mandatory to elaborate on the details of the project/thesis in a separate paper and attach it to the application. Page 2 of 4 7. Health a) Please indicate if you have some kind of health issues/disabilities such as dyslexia, dysgraphia, etc. which may influence your study process. Yes No If Yes, please deliver a confirmation from doctor, special needs representative, etc. with this application. b) Do you have some other type of health diseases/disabilities such as heart disease, epilepsy, diabetes, etc. affecting your daily or/and special activities? Yes No If Yes, please write what health diseases/disabilities you have: 8. Insurance a) Do you have a European Health Insurance Card if you are a European citizen or valid insurance from your home country if you come from an institution outside of Europe? Yes No If No, and you are a European citizen, please order it (for free) before you arrive to Norway. See how to order: http://ec.europa.eu/social/main.jsp?catId=563&langId=en#National_information_and_contacts b) Do you have a private insurance? Yes No If Yes, please write: Insurance company’s name: Policy number: Validation term: If No, we recommend to get private health/life/accident/travel insurance at least for the period of your stay in Norway. Page 3 of 4 9. Signature (Read carefully before signing) All information provided in this application, is to the best of my knowledge, correct. I am aware that providing incorrect information in this application may result in disqualification of my application. I have enclosed a certified copy of my transcript of records with the application: Yes No Place Date B2 level is described as follows: Understanding Speaking I can understand extended speech and lectures and follow even complex lines of argument provided the topic is reasonably familiar. I can understand most TV news and current affairs programmes. I can understand the majority of films in standard dialect. I can read articles and reports concerned with contemporary problems in which the writers adopt particular attitudes or viewpoints. I can understand contemporary literary prose. I can interact with a degree of fluency and spontaneity that makes regular interaction with native speakers quite possible. I can take an active part in discussion in familiar contexts, accounting for and sustaining my views. I can present clear, detailed descriptions on a wide range of subjects related to my field of interest. I can explain a viewpoint on a topical issue giving the advantages and disadvantages of various options. Signature Writing I can write clear, detailed text on a wide range of subjects related to my interests. I can write an essay or report, passing on information or giving reasons in support of or against a particular point of view. I can write letters highlighting the personal significance of events and experiences. Please send your application form with certified true copies of your certificates and diplomas to: international@hbv.no Page 4 of 4