International Office - University of Vienna
Student Application Form
Non-EU Student Exchange program with partner universities in Australia, Canada & USA:
Field of Study: ...................................................................................................................................................
Students Personal Data
Studienkennzahl: A 
 
Family name: ............................................................
First name: .....................................................
Date of birth: ...............................
Sex (m/f): .....................
Nationality: ...............................................................
Student ID: A-
Postal address:
...................................................................................
...................................................................................
Phone: ............................................................
...................................................................................
........................................................................
Email: .............................................................
Ranking of institutions
Period of attendance:
(Please number 1 - 3 in the order of your preference)
(Please tick according to your preference)
University of Illinois: ……
University of Chicago: ……
University of South Carolina: ……
Washington and Jefferson College: ……
University of Washington……
Duke University…...
University of Maryland…
Australia Australian National University: ……
Macquarie University: ……
Monash University: ……
University of Melbourne: ……
University of Queensland: ……
Queensland University of Technology:
…..
University of Sydney: ……
University of Western Australia: ……
USA
Canada
Carleton University : …… (for students
of Business Administration only)
Concordia University: ……
University of Alberta……
Université de Montréal: ……
Queen’s University ……
University of Ottawa: ……
University of Toronto: …… (for students
of English and American studies only)
fall term 2016……
fall term 2016……
fall term 2016……
fall term 2016……
academic year 2016/17……
fall term 2016……
fall term 2016…..
fall term 2016……
fall term2016……
fall term 2016……
fall term 2016……
fall term 2016……
spring term 2017…….
spring term 2017………
spring term 2017………
spring term 2017………
fall term 2016……
spring term 2017………
fall term 2016……
fall term 2016……
spring term 2017………
spring term 2017………
fall term 2016……
winter term 2017……
fall term 2016……
winter term 2017………
winter term 2017………
fall term 2016……
academic year 2016/17……
fall term 2016……
fall term 2016……
academic year 2016/17……
spring term 2017………
spring term 2017….
spring term 2017………
spring term 2017………
spring term 2017………
spring term 2017………
spring term 2017………
winter term 2017……
winter term 2017……
Have you passed the TOEFL or IELTS test?
If yes, please indicate date and score:
Date: ........................ Score: ..............
If no, for which date did you register? .....................
When do you expect to receive your score?
..................
For French-speaking universities (Université de Montréal/University of Ottawa)
Have you passed a language test (e.g. DELF, DALF)?
If yes, please indicate the level (e.g. B1, B2):
Date: ........................ Score: ..............
If no, for which date did you register? .....................
When do you expect to receive your score?
..................
Other language skills: ..............................................................................................................................
..................................................................................................................................................................
Declaration
I have read the information on the Non-EU Student Exchange Program available at the International Office´s
website of the University of Vienna. I realize that some university agreements have special requirements which
I have to fulfill in order to apply for them.
I wish to apply for the program(s) that I indicated on the first page of this application form. I hereby certify that
I fulfill the application qualifications according to the University of Vienna’s scholarship requirements.
Furthermore, I certify that the statements I have made on this application are true and correct. I know that I
have to repay the scholarship if my application shows contradictory or false statements. I will inform the
International Office in case there are any alterations to this application or in case I will receive any other
scholarship. I understand that the application process may include supplementary documents which I agree to
complete promptly.
I understand that in case of a nomination I will be studying on a non-fee/non-degree-status basis. I hereby
authorize my application to be distributed to other participants in the exchange program. I agree to participate
in a buddy program that offers support to incoming students. I further agree that neither the University of
Vienna nor the partner university will be held responsible for any liabilities whatsoever; furthermore, neither
the University of Vienna nor the partner university shall be required to purchase any insurance against loss or
damage to any personal property to which this application relates.
Due to the limited number of places and the fact that nominated students must be distributed on the first or
second semester of the academic year, I understand that in case of a nomination the period of attendance may
be different from the one I indicated on the first page of this application form.
I am responsible to cover and pay for any desired health/accident/travel insurance myself. In any case I will
maintain my present health insurance during my stay abroad.
Applicant's signature: ...........................................
Date: .........................