MACKENZIE PRESBYTERIAN UNIVERISTY INTERNATIONAL … · MACKENZIE PRESBYTERIAN UNIVERISTY INTERNATIONAL OFFICE 3 International Office Campus São Paulo: Rua da Consolação, 896 –

MACKENZIE PRESBYTERIAN UNIVERISTY INTERNATIONAL OFFICE

1 International Office

Campus São Paulo: Rua da Consolação, 896 – Ed. João Calvino - Térreo Consolação São Paulo - SP CEP 01302-907

Tel.+ 55 (11) 2766-7038 www.mackenzie.br/coi.html e-mail: [email protected]

INTERNATIONAL ACADEMIC MOBILITY PROGRAM

Ref.: Application Form for Academic Mobility Academic Year:

SECTION A – Program Details

SECTION B - Your Personal Details

FAMILY NAME

GIVEN NAME

MIDDLE NAME(S)

PREFERRED GIVEN NAME

DATE OF BIRTH (DD/MM/YYYY)

COUNTRY OF NATIONALITY

HOME ADDRESS

POSTAL CODE

CITY

STATE/PROVINCE

COUNTRY

PHONE

MOB:

E-MAIL:

PASSPORT NUM

INTENDED LENGHT ✔

1 SEMESTER

2 SEMESTERS

FEB./JUL

AUG./DEC

MOBILITY CATEGORY ✔

COOPERATION AGREEMENT

ERASMUS MUNDUS

FREE MOVER

TITLE (Mr, Mrs, Ms, Miss):

Sex: F M PHOTO

ATTENTION

Before completing this form, please pay attention to all the fields. Any errors resulting from failure to do so

may delay your application. Please write in BLACK BLOCK CAPITALS. COMPLETE ALL SECTIONS.





SECTION C - Academic Information

NAME OF THE HOME INSTITUTION

ADDRESS

POSTAL CODE CITY STATE/PROVINCE

COUNTRY

PHONE

INTERNATIONAL OFFICER (RESPONSIBLE):

NAME STAMP

E-MAIL

SECTION D - Nominated Agents

Data Protection: Mackenzie Presbyterian University will normally only discuss your application with you. If you wishto nominate a third party with whom we may discuss your application and accept his direction on its handling, pleaseprovide his details. Please note that a nominated third party will be able to amend or withdraw the application on your behalf.

Name of agent and email address Document number Relationship to you Agent’s date of birth

SECTION E - Details of Previous Higher Education (degree level or equivalent)

University/Institution Start Year Year of Completion

Qualification obtained

Main subject

SECTION F - About Your Language Skills Is Portuguese your first language? YES NO If you have knowledge of languages other than Portuguese (including your native language), please specify bellow the level of your competence. �Poor �Fair �Good �Excellent

�Poor �Fair �Good �Excellent �Poor �Fair �Good �Excellent





SECTION G – Proposed Funding Arrangements Please indicate below the main sources of funding you are most likely to use to fund your tuition fees, and living expenses, in the event that you are offered a scholarship from the University please indicate in the field “ Amount of funding” the category of the scholarship(Cooperation agreement, Erasmus, etc..). This is purely indicative at this stage and will not affect the assessment of your application in any way. Please tick if you have not yet made any alternative funding arrangements. �

Proposed Funding Sources e.g. family, scholarship, etc (If

government funds or foundations, please

specify)

Status

Amount of funding (R$)

(if known)

Period Covered (e.g. 1 semester, 2 semesters etc.)

Expenses Covered (please specify whether this is University

tuition fee or living expenses)*

�Intend to apply

� Applied for � Firmly secured

�Intend to apply � Applied for � Firmly secured

*PLEASE NOTE: MACKENZIE PRESBYTERIAN UNIVERSITY WILL ONLY REQUIRE TUITION FEES OF THE APPLICANTS OF THE CATEGORY “FREE MOVER”

SECTION H: Supporting Documents/Materials Checklist

Supporting materials are required with all applications.

Check the our page with Instructions on how to fill the application form for academic mobility (available here) very carefully to ensurethat you understand which supplementary documents/ materials must accompany your application. You must send all supporting documents/ materials by the deadline for your program. Any delay in sending the correct materials to the International Office will most probably result in your application not being considered.

If you encounter difficulty in gathering the materials in time for the deadline, please contact the International Office [email protected] for advice. We may be able to suggest ways to help you meet our requirements, but only if you contact us well in advance of the application deadline.





SECTION I – Learning Agreement DETAILS ABOUT THE STUDENT’S COURSE AT THE HOME INSTITUTION

NAME OF THE STUDENT LENGHT OF THE COURSE

HOME INSTITUTION STARTING DATE

CURRENT YEAR/ SEMESTER ENROLLED PROJECTED FINISH DATE

Learning Agreement CODE DISCIPLINE/SUBJECT CREDITS COLLEGE/FACULTY

_________________________ __/___/___ Student Date

HOME UNIVERSITY

We do confirm that the learning agreement provided on this application form is accurate, current complete and therefore approved by this Institution.

_______________________________ ___/___/___ _____________________________ ___/___/____

International Academic Representative Date Provost of International Affairs (or equivalent) Date

MACKENZIE PRESBYTERIAN UNIVERSITY (MPU) - HOST UNIVERSITY

The information provided in the learning agreement meets the requirements established by MPU, therefore we accept and approve the present learning agreement. ______________________________ ___/___/___ _____________________________ ___/___/___

Course Coordinator Date Director of the Academic Unity Date

* Free Movers from Institutions without a valid cooperation agreement with the host university will only be accepted under the approval of Provost for Graduate Education

Provost for Graduate Education ______________________________ Date ___/____/____





Once you have completed this application form, please read the following statements carefully. By signing this application forrm you confirm your acceptance of these statements. If you do not sign this form, we cannot process your application. • I confirm that the information I have provided on this application form is (to the best of my knowledge) true,

accurate, current and complete; and I agree to notify the University promptly if any information contained on this application form should change, in order to keep it true, accurate, current and complete.

PLEASE NOTE: All admissions decisions taken by Mackenzie Presbyterian University (MPU) rely on the statements made on the application form and in the supporting materials supplied by you and your referees. This information will be held and used for the purpose of processing your application for study, for student administration and, where relevant, for funding purposes. If the MPU believes that any information or statement, including references, contained on your application form may not be true, accurate, current and complete, it may take any necessary steps to verify that information or statement, or to confirm that any supporting material is entirely and legally true.

If, in the opinion of MPU, any information or statement, including references, provided on this application form, is not true, accurate, current and complete, or any supporting material is not entirely true, the University, represented by its International Office, retains the right to reject your application. If you have been made an offer by MPU, then the University, may in these circumstances withdraw or amend that offer. If you have been admitted as a student, you may be subject to disciplinary action according to the University Regiment in case of breach of any of the rules and principles of the Regiment.

In the course of completing this application form, you have provided the MPU with personal data. The consent set out below explains how this personal data may be processed by the MPU:

• I consent to the collection, processing, sharing and use of relevant personal data by MPU for the purposes of

processing my application for study, for administration and (if applicable) for funding purposes, subject to the provisions of the Federal Constitution, article 5, section X.

• I understand that MPU, will normally only discuss my application with me, unless I have nominated a third-party

agent on my application form. • I understand that if any information or statement, including references, provided on or to support this application

form is not true, accurate, current and complete, or any supporting material is not entirely true, the MPU may process and use this fact as relevant personal data. Such data may be used and shared with government bodies, to the extent necessary for the purpose of preventing fraudulent or dishonest applications for study, funding and/or visas.

• I understand that if I become a registered student, any personal data collected by the University as a result of my

application will form part of my student record.

SECTION J – DECLARATION





I, enrolled in the Institution______________________________________________, as regular student of course ______________________________________ want to apply for the International Academic Mobility Program, in one of the three categories previously chosen at the very beginning of this document, according to the information provided above. By doing so I promise to attend ____semester (s) in 20____. I am aware and in fully accordance with the following terms and conditions:

1. The final acceptance of the learning agreement prepared by the international applicant is of exclusively competence of the University, represented by its International Office.

2. I do promise to send a digital copy of my International Insurance policy and card to the address [email protected] within 10 days after receiving the e-mail from MPU with the digital copy of the Acceptance Letter.

3. I do promise to keep myself informed and strict follow the deadlines and orientations stablished by the International Office, concerning the deadlines of mobility schedule, which means that I fully agree on submitting all the documents required by the International Office and attend all the meetings organized by the host institution.

4. I will report exclusively to the International Office (by e-mail) any problems, concerns or doubts that I may have before, in the course of or afterwards the mobility program.

5. The student is responsible for solving any academic issues directly with the Academic Unity (Faculty) where he is located. It is his reputability to seek the International Academic Representative of his course in case of need.

6. I understand and I agree that my mobility Program can be cancelled anytime and my return home decreed by MPU, in case of non-compliance with the norms and the Program of Study.

7. If I lose my Student ID Card (TIA), I agree that I will pay a non-refundable fee in order to get a new card. The applicant is the responsible for ordering a new Student ID Card at the Financial Assistant to the Students Sector (AFA) in no more than two days.

8. The PPS must be approved by the Provost of International Affairs/ Chief International Officer (or equivalent) at the home institution before being sent to Mackenzie Presbyterian University.

9. I understand and agree that I am the only responsible for my registration at the Federal Police in Sao Paulo, in order to get my FOREIGN IDENTITY CARD AND INDIVIDUAL TAXPAYER REGISTRATION CARD, indispensable for my enrollment and matriculation at Mackenzie Presbyterian University

10. I understand that when I arrive in Brazil I will be able to change my learning agreement after a meeting with the IAR and Course Coordinator. I will have only 02 weeks (starting from the first class) to make the needed changes on my learning agreement. After that time In understand It will be impossible to change it.

PLACE AND DATE

SIGNATURE

PLEASE PRINT YOUR FULL NAME