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UNIVERSIDAD AUTÓNOMA DE CHIHUAHUAINTERNATIONAL SERVICES COORDINATION
3.0 STUDY ABROAD APPLICATION FORM
1. PERSONAL DATA (PROFILE) *FILL IN THE BLANKS.
Last name First name
Adress: Zip Code:
City/State:Telephone:
Cellphone:
Date and birth place:Nationallity:
Status:E-mail:
Gender:Passport number:
2. ACADEMIC INFORMATION
University:
Student id:Current Semester
Current Major: Total semesters:
General averageTuition:
College:
3. MOBILITY INFORMATION
Modality:
Academic Exchange a) One Semester b) Two Semesters Masters PhD Research Period: Summer Program
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UNIVERSIDAD AUTÓNOMA DE CHIHUAHUAINTERNATIONAL SERVICES COORDINATION
3.0 STUDY ABROAD APPLICATION FORM
Mobility Program: National Mobility (ANUIES) National Mobility (ECOES) CONAHEC Bilateral Agreement
Other(s):
4. MOBILITY INFO:
College of Universidad Autónoma de Chihuahua (U.A.CH.) that you want to
be:
Living time (starting date/ending date)
subjects to study:Semester or cicle to
study:
January-June
August-December
others:
NAME OF THE SUBJECTS THAT YOU WILL TAKE AT UNIVERSIDAD AUTÓNOMA DE CHIHUAHUA
Courses name Key/courses ID:
FOR RESEARCH PERIODS:
Researcher who recibe at UACH:
Project name:
Place for research development:
Name : Relationship:
Telephone: Address:
Cellphone: E-mail:
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UNIVERSIDAD AUTÓNOMA DE CHIHUAHUA
INTERNATIONAL SERVICES COORDINATION
3.0 STUDY ABROAD APPLICATION FORM
Name : Relationship:
Telephone: Address:
Cellphone: E-mail:
IN CASE OF EMERGENCY CONTACT:
DOCUMENTS REQUIRED
UACH STUDY ABROAD APPLICATION. ACADEMIC TRANSCRIPT. STATEMENT OF PURPOSE. COPY OF OFFICIAL IDENTIFICATION. 2 ACADEMIC RECOMMENDED LETTERS. PASSPORT. 3 PHPTOGRAPHS .( PASSPORT SIZE) 3/12 X 4/12 CMS INCLUDING THE ONE REQUESTED IN
THIS APPLICATION (COLOR) COPY OF MEDICAL INSURANCEPOLICY WICH STATES IT COVERS THE STUDENT DURING
HIS/HER ENTIRE STAY IN MÉXICO. CERTIFICATE BIRTH
*The documents must be sent to the UNIVERSIDAD AUTÓNOMA DE CHIHUAHUA (U.A.CH.) International Services Coordination, ONLY through home Institution.
Lic. Fátima Guzmán GallardoCoordinadora de Relaciones de Servicios Internacionales
Movilidad NacionalLarissa Rubio Chavarría
Movilidad InternacionalMiriam Chavira González
Circuito Interior Universitario s/n, Campus I, Chihuahua, Chih., México, C.P.31110
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NAME AND SIGNATURE
DATE
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