Graduate Non-Degree Student Exchange Application

This application should only be submitted one time. If you need to update your application information, please contact Graduate Admissions at enroll@jefferson.edu.

HIDDEN - Program - GR Foreign Exchange

Student Information

Legal First/Given Name

Middle Name

Legal Last/Family Name

Fill out the Preferred First Name field if you go by a preferred name or nickname that is different than your first/given name. Your preferred name will be used in admissions communications. If left blank, your first/given name will be used.

Preferred First Name (optional)

Preferred Last Name (optional)

Previous/Alternate First Name (optional)

What is your legal sex?

What is your current gender identity? (optional)

Other Gender

What is your preferred pronoun set? (optional)

Birthdate

Primary Citizenship

Dual Citizenship (if applicable)

Contact Information

Permanent Address

Country

Street

City

Region

Postal Code

Mailing Address

Country

Street

City

Region

Postal Code

Student Email

Mobile Phone

Home Phone

I permit Thomas Jefferson University to contact me via text and voice messaging. Standard messaging rates may apply.

Yes

Academic Program Information

Entry Term

Please select program that most closely aligns with the type of coursework you plan to take at Jefferson.

Current Institution

Please enter your home institution and your current major.

Institution Type

Institution Name

What is your major at your home institution?

Disclosures and Other Information

Have you ever been disciplined by any high school, college or university for unacceptable academic performance, inclusive of academic probation, suspension, and dismissal?

Please provide more information below including: a brief description of the incident(s), date of infraction(s), specific charge(s) and outcome(s), and a reflection on how this incident(s) has impacted your life.

Have you ever been disciplined by any high school, college or university for conduct violations?

Have you ever been convicted of a crime, including a felony or misdemeanor, or do you currently have any criminal charges pending against you in any court? Please note that conviction includes judgment, found guilty by a judge or jury, pleaded guilty or nolo contendere, received probation without verdict, disposition in lieu of trial, or ARD.

Additional Questions

If you have taken any test or coursework in English Proficiency (TOEFL, IELTS, ELS, Duolingo, Pearson's) please list the type of test/course you took, the test date, and the highest score received.

Certification

By choosing "I Agree", I certify that the information I have provided on this application is complete and accurate. I acknowledge that I have an ongoing obligation to promptly advise Thomas Jefferson University if my answers to any of the disclosure questions change and that failure to do so may result in the denial or revocation of admission and/or, if enrolled, dismissal from the University or other disciplinary action as appropriate. I understand that all records submitted in support of an application become property of Thomas Jefferson University and cannot be released to the applicant, any institution, or third party. I understand that deliberate falsification, misrepresentation, or omission of information on this application or my credentials, may result in the denial or revocation of admission and, if enrolled, will result in disciplinary action including dismissal from Thomas Jefferson University.

I Agree