Outbound Study Abroad Application Form

Winter 2025 Application Deadline: September 15, 2024

After submission of this online application please see "How to Apply & Required Documents" page for the necessary forms to be emailed to study.abroad@uregina.ca

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* denotes required field

PERSONAL INFORMATION:

First Name* Surname*
Student ID*
Street/PO Box*
City* Province*
Postal Code* Current Phone*
Email Address*
Date of Birth* Pronouns

EMERGENCY CONTACT INFORMATION:

Emergency Contact Name*
Emergency Contact email*
Relationship to you*
Emergency Contact Phone*

PROGRAM INFORMATION:

Faculty* Major*
Campus*

HOST INFORMATION:

1st Choice:
2nd Choice:
3rd Choice:
4th Choice:
5th Choice:

Which semester/s are you planning your exchange?
Fall Winter Fall & Winter

What year are you planning your exchange?

Have you discussed your study abroad plans with your academic advisor?
(If not, please make an appointment with them before proceeding with this application)
Yes No

Do you receive student loan/grant funding? Yes No

Have you previously participated in a study abroad program?
Yes No

Do you speak any languages other than English?
Yes No

Please specify language(s):

ACADEMIC REFERENCE:

Please note: Students are responsible for requesting their academic reference.

Name*
Email*
Department*
Phone*

STUDENTS REQUIRING ADDITIONAL SUPPORTS:

Do you require additional supports (academic accommodations)?
Yes No
If yes please contact the Centre for Student Accessibility for accommodations.

PRIVACY STATEMENT:

The U of R collects information under authority of The University of Regina Act in accordance with the Local Authority Freedom of Information & Protection of Privacy Act and the Personal Information Protection & Electronic Documents Act for purposes of enrolment, academic status, and administration of programs/services. By responding to this form, you consent the use your personal information to communicate with you about your request.

STUDENT DECLARATION:

Signature* Date*