Study Abroad Application Form

Fall 2023 Applications open NOW! Deadline: March 1, 2023

After submission of this online application please see "DOCUMENTS" page for the necessary forms to be emailed to

* denotes required field

First Name* Family Name*
Student Number*
Current Address*
City* Province*
Postal Code*
Current Telephone* Cell Number


E-mail Address*
Gender* Date of Birth*
Emergency Contact Name*
Emergency Contact email*
Relationship to you*
Emergency Contact telephone*
Faculty* Major*

Host Site

1st Choice:
2nd Choice:
3rd Choice:
4th Choice:
5th Choice:

Length of Exchange:

When are you planning on going?

Have you discussed your study abroad plans with your academic advisor?
Yes No (if not please make an appointment to see your advisor before proceeding)

Are you on student loans? Yes No

Have you participated in a study abroad program?
Yes No

Do you speak any other languages?
Yes No

Please indicate your academic reference


Do you have any special needs or require any additional supports?
Yes No
If yes please request the Center for Student Accessibility contact us with verification.

The U of R collects information under authority of The University of Regina Act in accordance with the Local Authority Freedom of Information & Protection of Privacy Act and the Personal Information Protection & Electronic Documents Act for purposes of enrolment, academic status, and administration of programs/services. By responding to this form, you consent the use your personal information to communicate with you about department name here.

Signature* Date*