FLT ACADEMIC EXCHANGE, COOPERATION AND MOBILITY PROGRAM STUDENT REGISTRATION FORM Nome Last name Student's name Semester you are coursing Sex Nationality Date of Birth Passport Number Date of issue of the passport Expiration date of the passport Permanent Address Phone (landline) Mobile Phone / Whatsapp E-mail It will be used by FLT to send you important information Emergency Contact: Name, Relationship and Telephone IMPORTANT: Below, the deadline for submission of this form and the required documentation. 1st Semester 1st Semester 1st Semester: 3 months in advance (end of November of the previous year) 2nd Semester 2nd Semester 2nd Semester: 3 months in advance (end of April of the current year) Along with this application form, the student is required to provide and to attach the following additional documents: Personal statement I – Personal statement indicating the reasons for choosing Brazil and FLT as an Exchange Program location Passport II – Scanned copy of Passport Academic Transcripts III – Official Academic Transcripts Study Plan IV – Study Plan, accompanied by a Statement by the Course Coordinator approving this Plan Financial aid V – If applicable, provide documentation regarding any financial aid, grants and/or scholarships Medical Insurance VI – Provide proof of Medical Insurance Coverage for International Travel along with information booklet describing benefits for the entire intended stay in the designated country and repatriation in case of serious illness, accident or death Important: Prior to his/her arrival to Brazil, it is the exchange student´s responsibility to apply for and obtain a student visa from the Brazilian consulate and to purchase an international medical insurance plan that provides coverage for the entire intended stay. Signature * I confirm the accuracy of the information provided here. By selecting the checkbox, you declare that the information provided is true and endorse it.
