Bond University Exchange • Pre-Departure Form

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					                                                                                                        Student Name:


                                                                                                        Student ID Number:


                                                                                                        Exchange Semester:
University Drive, Robina
Queensland 4229 Australia
Ph: +61 7 5595 1 1 1 1
Fax: +61 7 5595 1015
(from overseas)
CRICOS CODE 00017B




                     Bond University Exchange • Pre-Departure Form
1        Student Exchange Details                                            Final Semester at Bond?                    Yes         No
Country of Citizenship:                                                  Host Institution:



Health Insurance Provider:                                               Overseas Contact Phone Number:



Health Insurance Policy Number:                                          Citizenship



Next of Kin:                                                             Overseas Residential Address:



Next of Kin Telephone Number:



Passport Number:                     Passport Expiry Date:
                                                                                         State                          Postcode/Zip code


Visa Number:                         Visa Expiry Date:                                   Country
                                                                         Email



2        Travel Itinerary
Leaving From (Australian City):                                          Airline:



Departure Date (dd/mm/yyyy):                                             Flight Number:



Going To (Host City/Country):



Arrival Date (dd/mm/yyyy):                                               Overseas Residential Address:



Multiple Destination Route (if applicable):



I am aware that while on exchange I am a representative of Bond University and my country. I will behave in an appropriate and respectful
manner. I declare the above information is correct and will notify the Bond Office of Recruitment and Admissions if any changes occur.




                                                                                                         /       /
Signature of applicant                                                                                    Date
3         Exchange Grant Application
IMPORTANT: In order for this grant to be processed, you must submit the following to the Office of Recruitment and Admissions:

1) Attend Pre-Departure Information Session at Bond University prior to going on exchange
2) Photocopy of your Visa;
3) Proof of overseas health insurance;
4) Completed pre-departure form (previous page)
5) Completed exchange report and presentation confirmation

Grant money will be credited to your student account, provided all fees have been paid. You may apply for a refund, enabling the
money to be transferred to your personal account.

4         Terms and Conditions
I understand that the payment of my tuition fees for my exchange semester will be due before the commencement of the exchange
semester. If these fees are not paid, my transcript from the Host Institution will be withheld and credit from the Host Institution will
not be transferred to my Bond University degree.
I understand that this grant money is provided on the condition that I complete an entire semester at the exchange partner
institution. Failure to remain for this period may result in me being required to repay the grant in full. *
I understand that I will receive an initial grant payment of $1000.00 and the remaining $1000.00 will be paid to me upon completion
of my report and proof of a completed presentation. I understand that in order to remain eligible for the grant, it is my responsibility
to submit the required forms and supporting documents to the Study Abroad and Exchange Office upon the completion of my
studies while on exchange at the host institution or I will forfeit any outstanding exchange funding.*
Applicable to Soochow Students ONLY:
I understand that Bond will pay Soochow for the registration and tuition fees on my behalf and will subsequently withhold an amount
from my funding to cover the registration and tuition fees. This amount may be subject to change for various reasons including
fluctuating exchange rates and changes to Soochow fee structures. I also understand that I must provide airfare receipts and
itinerary*
Applicable to Alcala University - Alcalingua Students ONLY:
I understand that I am required to pay my fees at Bond for three subjects. Faculty of HSS will pay the Alcalingua language fees once
an invoice is produced. ORA will fund the exchange grant of $2000 as per the terms and conditions outlined in the predeparture
form. This will be limited to 2 students per year, and beyond this Faculty of HSS will fund the grant. *
*These amounts are correct as at 01 March 2007. Payment of all grants are at the discretion of the University and are subject to
change without notice.




                                                                                                                      /          /
Signature of applicant                                                                                                    Date




                                                                 OFFICE USE ONLY
Amount                                 Date to be Paid                                                                               Approval   Date
Grant Req.                             Attended Pre-departure Session at Bond
GENERAL GRANT MONEY - COST CENTRE - 1-FP-807102
$1000.00                               Pre-departure Form completed, upon exchange approval.
$500.00                                Upon completion of report.
$500.00                                Upon completion of presentation (confirmed by host institution).
                                       Alcalingua Tuition to be paid by HSS on receipt of invoice from Alcalingua (Cost Centre
                                       1BP-805215)
DEST - Endeavour Program (must complete form, report and presentation prior to receiving)
                                       DEST Endeavour Program - UMAP (1FR1 804203)
                                       DEST Endeavour Program Cheung Kong (1FR2 804203)
SOOCHOW + TSINGHUA- only this section must be completed - Denis Jen Cost Code 7111

$1000.00                               Pre-departure Form completed, upon exchange approval. Upon receipt of airfare
                                       receipts.
$500.00                                Upon completion of report.
                                       Soochow Tuition to be paid by ORA (7111 804203)

                                       Upon completion of presentation (confirmed by host institution). This amount is the
                                       remainder from the invoice and $1500 paid from $3000 available in total.

				
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Description: Bond University Exchange • Pre-Departure Form