Food Business and Development

In: Business and Management

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University College Cork & University of California

Undergraduate Exchange Programme

2016-2017 Academic Year

(1) Last name: _______________________________________________________

(2) First Name: _______________________________________________________

(3) Student Number:___________________________________________________

(4) Date of Birth:___________________

(5) Address for correspondence__________________________________________

___________________________________________________________________

___________________________________________________________________

(6) Telephone No:_____________________________________________________

(7) Email Address:_____________________________________________________

(8) State Academic Record:

(a) Degree course currently registered for:____________________________

(b) State Examination Results to date (e.g. 2nd Class Honours in First Year etc.):

___________________________________________________________________

___________________________________________________________________

(9) Name of Head of Department or lecturer from whom you have requested a statement of support:

___________________________________________________________________

Signature: _______________________________________

Date:____________________________________________

When completed, please return this form to:

Marita Foster
International Office
Roseleigh
UCC

By 5.00pm, Friday, December 4th 2015

PERSONAL STATEMENT

Please outline your reasons for applying to participate in the exchange programme.

Signature: Date:

STATEMENT OF SUPPORT FROM HEAD OF DEPARTMENT OR…...

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