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            NSE Logo                            Applicant's Name     _____________________________________________


Please complete the information requested on this form regarding how your proposed exchange will contribute to your academic and personal development as well as why you have selected particular colleges and/or universities as exchange sites. Add additional pages if necessary. Submit this statement to your academic advisor or department chairperson for approval and signature prior to returning the form to the NSE coordinator.


NOTE:  It is suggested that a copy of the signed form be retained in the student's advisement file.

To Be Completed By The Applicant:


NSE Campus(es) for which you are applying:                                                                            

  1. ______________________________________________________________
  2. ______________________________________________________________
  3. ______________________________________________________________
  4. ______________________________________________________________
  5. ______________________________________________________________


Why have you selected the campuses you have listed as possible exchange sites?







What are your academic aspirations while on exchange and how will they contribute to your degree program?








Do you expect to take courses in your major or are you more interested in non-major courses?







What courses are you considering taking while on exchange?








How will going on exchange contribute to your personal development? 








What do you hope to accomplish on exchange that you could not do at your home campus?












Approval by the Department Chairperson/Academic Advisor:


Name (print) ___________________________________         Title       _____________________________________

Phone   ________________________                                      e-mail   _____________________________________

Signature     __________________________________            Date      _____________________


Return this form to: 


Emily K. Mason

130 Gaines Hall

P.O. Box 173000

Bozeman, MT 59717-3000