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.