1、英国邓迪大学 3+1+1 交流项目申请表A. Programme and Subject area you wish to Study 3+1+1 China ProgrammeAcademic Subject area(s) :Entry Year: 2016/17B. Personal DetailsSurname / Family Name : Title : Mr / Miss / Ms / Mrs/ Dr Male / Female (Please circle)First & Middle Name(s) : Date of Birth (dd / mm / yyyy) d d /
2、 m m / 1 9 y yName by which you would like to be known : Previous Surname:Permanent Home Address Correspondence/Contact Address City : City :Country : Country :Postal code/ Zipcode : Postal code/ Zipcode :Home Email : Contact Email :Telephone Number(s) (with Country and Area Code)Tel:Mobile/Cell:Tel
3、ephone & Fax Number (with Country and Area Code)Tel:Fax:Nationality: Passport Number (if non-UK/EU) :Country of Birth: Country of Permanent Residence:C. Additional Information1 Disability : The University encourages applications from students with disabilities and special needs and is keen to provid
4、e appropriate support for study and/or accommodation. If you have a disability, special needs (including dyslexia) or medical condition, please tick the appropriate box and enclose further details where necessary. Tick A for no disability or support requirements :A A. No disability or awareness of a
5、dditional support requirementsA B. You have a social/communication impairment such as Aspergers syndrome/other autistic spectrum disorderA C. You are blind or have a serious visual impairment uncorrected by glassesA D. You are deaf or have a serious hearing impairmentA E. You have a long standing il
6、lness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsyA F. You have a mental health condition, such as depression, schizophrenia or anxiety disorderA G. You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)DA H. You have physical impairment
7、 or mobility issues, such as difficulty using your arms or using a wheelchair or crutchesA I. You have a disability, impairment or medical condition that is not listed aboveA J. You have two or more impairments and/or disabling medical conditionsD. English Language to be completed by ALL applicants
8、Students participating in all programmes must show sufficient proficiency in English Language to fulfill the demands of the programme. The English language level demanded of students studying at the University of Dundee is a minimum of the following (or equivalent): IELTS 6.0TOEFL (internet) at 77In
9、dicate any internationally recognised qualifications gained as proof of English Language level and the score/grade achieved (e.g. IELTS, TOEFL, Cambridge, IGCSE, International O-Level). You must have completed these exams and received the results prior to matriculation.Test type(e.g. IELTS, or TOEFL
10、, etc)Score/Grade Date/Expected date of Test and location of Test centreIELTS TRF number orETS id number (if applicable)Further information about English Language requirements can be obtained at www.dundee.ac.uk/admissions/international/english_language_requirements.htmE. Details of your Current Hom
11、e University or CollegeName of your Home InstitutionName of your Course at Home Institution. Indicate Major, if known.Details of your Personal Course Tutor at Current Home InstitutionNameTitleDepartmentTelephone Number EmailF. Personal Statement in Support of ApplicationPlease use this section to te
12、ll us why you wish to study on a Visiting Programme at the University of Dundee, how it will relate to your present academic program and what benefits you expect to receive from the program. Include any other relevant information which has not been included elsewhere in this form. This might include
13、 relevant practical experience, outside interests, or other academic/professional interests or qualifications. Continue on an extra sheet, if required.G. Approval from your Home UniversityDetails of your Course Director or Study Abroad Coordinator, as relevantNameTitleDepartmentAddressTelephone Numb
14、er Fax NumberEmail H. Supporting DocumentsPlease tick the relevant boxes below to indicate which copies of documents you have enclosed with your completed application form.A IELTS/TOEFL Certificate A Academic Transcript of Studies from your home UniversityA Approval Letter from your home University
15、A Passport front page photocopyA Studying Certificate from your home University A Other give details_I. Student DeclarationI certify that the information given on this form is true, complete and accurate. If I am admitted to the University, I undertake to observe the Universitys Ordinances and Regul
16、ations and to ensure payment of any tuition fees and other financial liabilities to the University, as relevant.I accept that information about my progress on the Visiting Programme may be shared with my Home University.I agree to inform the University immediately if I decide not to proceed with my application.Applicant Signature: Date:
