Application for Courses |_| Autumn Semester 2002 |_| Spring Semester 2003

Deadline:
April 15th 2002 (Autumn Semester), October 15th  2002 (Spring Semester)
For students who are part of formal programmes (ERASMUS, NordPlus or
Bilateral agreements) the deadlines are May 15 2002 and November 15 2002.

I. PERSONAL INFORMATION

Last name __________________________________________________________________

First name _________________________________________________________________

Date of birth ( year-month-day ) ___________________________________________

|_| male   |_| female

Citizenship ________________________________________________________________

Present mailing adress _____________________________________________________

____________________________________________________________________________

Present phone number incl area code ________________________________________

Present fax number incl area code __________________________________________

Present e-mail address _____________________________________________________

Adress, phone & fax valid until (month, day)________________________________

Permanent mailing adress____________________________________________________

____________________________________________________________________________

Permanent phone no incl. area code _________________________________________

Permanent fax no incl area code ____________________________________________

Mother Tongue ______________________________________________________________

II. ACADEMIC INFORMATION

|_| Undergraduate student      Major subject _______________________________

|_| Graduate student           Major subject _______________________________

Do not forget to enclose transcript of record from your home university !
(translated to english for free movers)

Please rate your ability in the English language.

Speaking      |_| excellent    |_| good    |_| fair     |_| poor
Reading       |_| excellent    |_| good    |_| fair     |_| poor
Writing       |_| excellent    |_| good    |_| fair     |_| poor

I have taken an English language test (TOEFL/IELTS) ________________________
(Please attach !)                                   type of test and result

Mark your exchange program

|_| Erasmus  |_| Nordplus  |_| Tempus  |_| Other ___________  |_| Free Mover

III. COURSE APPLICATION / LEARNING AGREEMENT

I apply to the following courses (each course 5 credits) 

1. ________________________________________________ Course Code ___________

2. ________________________________________________ Course Code ___________

3. ________________________________________________ Course Code ___________

4. ________________________________________________ Course Code ___________

5. ________________________________________________ Course Code ___________ 

6. ________________________________________________ Course Code ___________

7. ________________________________________________ Course Code ___________ 

8. ________________________________________________ Course Code ___________

REGISTRATION FIELD (not to be filled in by applicant)

         | Institution    | Antagn.enhet  |   
         | Datum Sign.    | Datum Sign.   |
         |                |               |
      1. |________________|_______________|
         |                |               |
      2. |________________|_______________|
         |                |               |
      3. |________________|_______________|
         |                |               |
      4. |________________|_______________|
         |                |               |
      5. |________________|_______________|

The normal workload is 20 credits per semester; 40 credits per academic
year. One Swedish credit (point) equals 0.6 American credits and
1.5 ECTS-credits.

Exchange students can register for studies comprising a maximum of 40
Swedish credits (max. 60 ECTS-credits) per academic year.

Signature _________________________________________    Date _______________
          (applicant)

Home university ___________________________________________________________

Departmental co-ordinator _________________________________________________
                          (home university)

Umeå University department of _____________________________________________
(Host university/department)

Departmental co-ordinator _________________________________________________
                          (host university)

IV. INSTRUCTIONS TO APPLICANTS

The following is a list of other documentation required; please check that
all documents are enclosed:

|_|   Official university transcript(s) from all post-secondary
      institutions atttended (translated in English)

|_|   Passport size photo (please attach to application form)

|_|   Curriculum vitae

The application should be returned in duplicate to:

Umeå University,
International Office,
Mrs Eivor Lundgren,
S-901 87 Umeå,
Sweden