INTERNATIONAL STUDENT REGISTRATION + APPLICATION + DAR and HOUSING FORMS

Transcrição

1 Photo () with white background INTERNATIONAL STUDENT REGISTRATION + APPLICATION + DAR and HOUSING FORMS PERIOD OF STUDY AT PUC-Rio (Please choose of the options below) Intensive: Yes No Intensive Only: January July Semester: 1 semester 2 semesters REGISTRATION AS Exchange Student: Classes in Portuguese Classes in English (only if allowed by home institution) Special Student: Classes in Portuguese Classes in English Double Degree Student ( classes in Portuguese only): EXTRA NEEDS WHILE IN PUC-RIO Will you request accommodation indicated by PUC-Rio? Yes (If so, please fill pages 5 and 6) No Do you wish to rent a cell phone? Yes No PERSONAL DATA STUDENT INFORMATION First Name: Middle Name: Last Name: Born: / / (dd/mm/yyyy) Place of Birth: Nationality: Marital Status: St/Ave: Number: Complement: Zip Code: City: State: Country: TELEPHONE NUMBER phone 1 : phone 2 : - Please do not use Hotmail: PASSPORT INFORMATION Passport Number: Cell: Fax: Nationality: Date of Expiration: / / (dd/mm/yyyy) Issued by (Country): 1/6

2 CONTACTS FATHER S NAME First Name: Middle Name: Last Name: St/Ave: PERMANENT ADDRESS Number: Complement: Zip Code: City: State: Country: TELEPHONE NUMBER Country Code: City code: Number 1 : Number 2 : Country Code: City code: Cell 1 : Fax 1 : Please do not use Hotmail: MOTHER S NAME First Name: Middle Name: Last Name: St/Ave: PERMANENT ADDRESS Number: Complement: Zip Code: City: State: Country: TELEPHONE NUMBER Country Code: City code: Number 1 : Number 2 : Country Code: City code: Cell 1 : Fax 1 : Please do not use Hotmail: INFORMATION FOR EMERGENCY CASE (CONTACT PERSON) First Name: Middle Name: Last Name: St/Ave: PERMANENT ADDRESS Number: Complement: Zip Code: City: State: Country: TELEPHONE NUMBER Country Code: City code: Number 1 : Number 2 : Country Code: City code: Cell 1 : Fax 1 : Please do not forget to sign the application form. 2/6

3 Please do not use Hotmail: ACADEMIC INFORMATION University Institution Company Specific Name: Undergraduate Graduate Position/Course: First-year Sophomore Junior Senior Major (if applicable): Have you ever withdrawn from your university? Yes No From (dd/mm/yyyy): / / to / / Scholarship: Yes No Loan: Yes No Type: Last term GPA: Total of academic credits obtained: Teaching assistant activities: Yes No From (dd/mm/yyyy): / / to: / / Activities: Internship? Yes No From (dd/mm/yyyy): / / to: / / Activities: FOREIGN LANGUAGES Portuguese Level: From (dd/mm/yyyy) : / / to / / English Level: From (dd/mm/yyyy): / / to / / French Level: From (dd/mm/yyyy): / / to / / Spanish Level: From (dd/mm/yyyy): / / to / / German Level: From (dd/mm/yyyy): / / to / / Other: OTHER INFORMATION Have you ever lived in Brazil? Yes No State: Period of time: Have you ever lived in any other country? Yes No Which ones? Courses of interest at PUC-Rio: Please do not forget to sign the application form. 3/6

4 A- ONLY PORTUGUESE AS SECOND LANGUAGE INTENSIVE COURSE STUDENTS I declare that: 1. The information given above is true, correct and current; 2. I am aware that PUC-Rio will accept no responsibility for students who choose to expose themselves living in risky places, i.e., slums, rented apartments or flats instead of living in safe locations indicated by the International Programs Central Coordination Office Accommodation Program; 3. I am aware that the Portuguese as a Second Language Intensive Course is NOT a regular course at PUC-Rio and thus a R$ 1500,00( Hum thousand and fifty hundred reais) fee is charged of all enrolled students, including exchange students from partner universities; 4. I am aware that I must send the complete application and the pre-term Portuguese as a Second Language Intensive Course payment and respect PUC-Rio deadlines in order to be accepted; 5. I accept and I will pay the orientation/activities fee (R$100,00 ( One hundred reais) for the Portuguese for as a Second Language Intensive Course period. 6. Enclosed: A copy of the R$ 1600,00 ( On thousand and six hundred reais) money order or wire transfer sent to Faculdades Católicas. WIRE TRANSFER Bank Itaú Account # Branch 1108 Account name: Faculdades Católicas Overhead Bank address: Rua Marquês de São Vicente 225, Ed. Pe. Leonel Franca 8º andar, CEP Gávea Rio de Janeiro RJ - Brazil Bank SWIFTI Routing address: ITAUBRSPSPO (Refunds will be issued ONLY up to one month prior to the course start date) B- ONLY REGULAR TERM STUDENTS I declare that: 1. The information given above is true, correct and current; 2. I accept and I will pay the orientation/activities fee charged upon arrival by the International Programs Office (Exchange Students pay a R$250,00 ( Two hundred and fifty reais) orientation/activities fee and Special students pay a R$ 500,00 ( Five hundred reais) referent to the registration and orientation/activities fee ). (Refunds will be issued ONLY up to one month prior to the course start date) 3. In case I have registered for a year or request extension of my student exchange period, I accept and I will pay the renewal of the orientation/activities fee charged during the deadline for the Exchange Period Extension. (Exchange Students pay the amount of R$ 100,00 ( one hundred reais) and Special and Extension Students pay the amount of R$ 250,00 ( Two hundred and fifty reais). 4. In case of any changes in my current address in Brazil, I must contact the International Programs Central Coordination Office as well as the Federal Police within 30 days. I am aware that PUC-Rio will accept no responsibility for students who choose to expose themselves living in risky places, i.e., slums, rented apartments or flats instead of living in safe locations indicated by the Accommodation Program; 6. I am aware that I must comply with all the academic and financial requirements in order to obtain PUC-Rio s transcript in the end of the semester. C- PORTUGUESE AS SECOND LANGUAGE INTENSIVE COURSE + REGULAR TERM STUDENTS: Must be aware of both information given above in the itens A and B situations. Date (dd/mm/yyyy): / /. Student signature ( mandatory) 4/6

5 HOMESTAY HOUSING QUESTIONNAIRE PREFERENCES Describe the kind of person you are (easy going, assertive, independent, picky eater, etc.): List your special interests (academic, subjects, hobbies, sports, etc.): Do you have pets: Yes No Which ones? Would you accept to live in a place that have pets: Yes No cat dog birds Other Which Ones? Do you smoke: Yes No Would you accept to live in a place where there are smokers? Yes No Please indicate any special food restriction (vegetarian, religious requirements, etc.). Do you have any restrictions related to diseases like allergy or asthma (humidity, carpets, curtains, etc.)? Are there any specific living conditions you can not tolerate? Please indicate any health conditions, disability or special needs (requiring special access, etc.) that might affect your housing needs. Other comments or special interest: The number of host families indicated by PUC-Rio is limited. In order to apply for housing arrangements candidates must send the accommodation form enclosed with the required documents respecting PUC-Rio deadlines. Accommodation requests will be considered only after ALL admittance documents have been received and upon the availability of homes. Be aware that the family housing will be provided as a first-come first-served service. The official arrival date informed on the International Programs Calendar is, also, the official entrance date in the homes. Students are not allowed to arrive at the homes before the official arrival date. Students are not allowed to bring pets. Date (dd/mm/yyyy): / /. Student Signature 5/6

6 STUDENT TERM OF COMMITMENT FOR HOUSING I,, hereby declare that, due to my participation in the Housing Program indicated by PUC-Rio, am aware that I must observe the conditions stated below. 1 The importance of R$750,00 (Seven hundred and fifity Reais ) that will be charged is referent to an individual room with fan, change of sheets and towels every week, light, gas and a Brazilian breakfast (coffee, milk, bread, butter, jelly and fruit). The use of telephone, internet acess, air-conditioner, personal hygiene products (shampoo and soap) and the laundry of personal clothes may be agreed between both parts. The first payment must be made until the 3rd day of residence and the rent of subsequent months must be paid until de 5 th day of each month. The payment of posterior months does not need to be anticipated. 2 The student must be aware of the existent rules regarding other areas of the house (living room, kitchen, etc), as well as the use of electric and electronic devices and the possibility of receiving visits. S/he will receive only one copy of the house s keys that must be returned to the family when finished the period of permanence in the house. No other copies are to be made. Under no circumstances the house s keys will be handed to anyone else. 3 Whether the housing program is cancelled by the family, the must receive a written communication and the student must be informed, both of them within 30 days prior. In case the student wants to leave the family s house, s/he must inform the family and notify the International Programs Central Coordination Office through a written communication, with 30 days prior. In case the family does not respect the 30 day deadline, the student will receive an integral reimburse of the month. On the other hand, if the student does not respect the same deadline, s/he must pay the family a R$750,00 (Seven hundred and fifity Reais ) fine. 4 - The student must inform the () and the Federal Police about any changes in his/her address, within 30 days. 5 - PUC-Rio is not responsible for students who decide to live in risky places (i.e., slums) instead of living in the family s houses indicated by the Accommodation Program. 6 PUC-Rio intermediates the introduction of exchange students to families interested in receiving them, not being responsible for the rent payment, debits made by students, or the disrespect of the rules agreed between the parts at the moment the student moved in. On the other hand, PUC-Rio supports and helps both parts on improving the interaction between them. Date (dd/mm/yyyy): / /. Student Signature 6/6

7 CADASTRO DE ALUNOS Student Registration DAR CURSO DE(degree): ( ) Graduação (undergraduate) ( ) Pós-Graduação (graduate) ( ) Aluno Conveniado (Exchange Student) Instituição de Origem (home institution): Ou programa (Program): ( ) ISEP ( )AUSJAL ( ) CREPUC ( )LAE3 ( ) Aluno Extraordinário (Special Student) Instituição de Origem (home institution): Nº de Matrícula (registration number) NÃO PREENCHA O Nº DE MATRÍCULA. ELE SERÁ FORNECIDO QUANDO ESTE FORMULÁRIO FOR RECEBIDO PELA. (DO NOT COMPLETE THE REGISTRATION NUMBER. IT WILL BE GIVEN WHEN RECEIVES THIS FORM) Primeiro Nome (First name) NOME DO ALUNO (STUDENT NAME) Segundo Nome (Midle name) Terceiro Nome (Last name) Primeiro Nome (First name) NOME DO PAI (FATHER NAME) Segundo Nome (Midle name) Terceiro Nome (Last name) Primeiro Nome (First name) NOME DA MÃE (MOTHER NAME) Segundo Nomes (Midle name) Terceiro Nome (Last name) Data de Nascimento (dd/mm/aaaa) Estado Civil Sexo (date of birth dd/mm/yyyy) (marital status) (sex) 1. Solteiro (single) 2. Casado (married) 3. Viúvo (widow) 4. Separado Judicialmente (legally separated) 5. Divorciado (divorced) 6. Outros (other) 1. Masculino (male) 2. Feminino (female) País de Nascimento (country of birth) Nacionalidade (nationality) As informações têm que coincidir com as que constam no seu passaporte! (The information must be identical to the ones in your passport) 07/08

8 N o do Passaporte (passport number) Órgão Expedidor (issued by) Data de Expedição (dd/mm/aaaa) (expedition date dd/mm/yyyy) Tipo de Visto (visa type) Data de Validade (visa expiration date - dd/mm/yyyy) Se você ainda não tem um tipo de visto não é necessário completar agora, mas a informação será necessária na sua chegada. (if you don t have a visa type yet, you don t need to complete now, but the information will be requires upon your arrival). 1. Estudante (student) 2. Diplomata (diplomat) 3. Turista (tourist) 4. Trabalhador Temporário (temporary employee) 5. Dependente de trabalhador temporário (temporary employee dependent) 6. Outros (other): Endereço permanente País de Origem (permanent address - home country) Número Bloco Apt. Cidade (number) (complement) (apt. number) (city) CEP País Estado (zip code) (country) (state) - DDD (área code) Telefone (phone) Ramal (extension) Endereço no Rio de Janeiro (onde o (a) aluno (a) reside no momento). Não preencher se for o mesmo endereço acima ou se ainda não tiver endereço do Rio de Janeiro. (Address at Rio de Janeiro (where the student currently live). Do not complete itif it is the same address above or if you don t have address in Rio yet) Bairro (neighborhood) CEP (zip code) - DDD (area code) Telefone (telephone number) DDD (area code) Telefone de contato (contact phone) Ramal (extension) Rio de Janeiro, / / (dd/mm/aaaa) (dd/mm/yyyy) Declaro que as informações acima são verdadeiras e atuais. (I declare that the information above is true and current) Assinatura do (a) Aluno(a) Student Signature 07/08