Exchange Student Nomination Form

Home University Information
Please use this online form to nominate your students to the UMW exchange program. Nominations for the Fall semester are due March 30th. Nominations for the Spring semester are due September 30th.
Home University Name*
Contact Person/Office*
Email*
Exchange Student #1
Name*
First Last
Enter the term of your exchange (Fall, Spring, or Academic Year)
Year*

Enter the year of your intended exchange term.
Student E-mail*
Date of Birth*
Gender*
- Female
- Male
- Other/Not Specified
Major Field of Study/Major*
Exchange Student #2
Name
First Last
Enter the term of your exchange (Fall, Spring, or Academic Year)
Year

Enter the year of your intended exchange term.
Student E-mail
Date of Birth
Gender
- Female
- Male
- Other/Not Specified
Major Field of Study/Major
Exchange Student #3
Name
First Last
Enter the term of your exchange (Fall, Spring, or Academic Year)
Year
Student E-mail
Date of Birth
Gender
- Female
- Male
- Other/Not Specified
Major Field of Study/Major
Exchange Student #4
Name
First Last
Enter the term of your exchange (Fall, Spring, or Academic Year)
Year
Student E-mail
Date of Birth
Gender
- Female
- Male
- Other/Not Specified
Major Field of Study/Major

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