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NSE Placement Acceptance Form

Instructions

  1. Complete the missing information in Parts A, B & D on each copy of this form.
  2. Read Part C: Special Conditions or Circumstances on this form and scroll section on the Conditions of Placement.
  3. Sign and date this form and the Conditions of Placement.
  4. Click submit to email a copy of this form to both the HOME and HOST NSE Coordinators.

Placement is not confirmed until the PAF and the Conditions of Placement are submitted to the HOST NSE coordinator.

Part A – Participant Information - (Complete missing information.)

Current Address

Permanent Home Address

Part B – Placement Information - (Complete missing information.)

I ACCEPT my placement

At
On
For Exchange Period

Part C – Special Conditions

Voluntary disclosure helps your host campus provide appropriate support.

Questions below are designed as a self-assessment guide. It is not necessary to answer on this form, but if your answer to any of the questions in this section is YES, you should immediately identify yourself and your needs to your host campus coordinator. Notification at least two to three months prior to arrival on campus is necessary in order for your host institution to address your needs. You will be asked to submit documentation which is written, current, and prepared by a qualified professional in the manner and time period required by your host campus. You will also be asked to identify the kind of arrangements that are currently being made for you at your home campus. Consult home and host disability service coordinators for additional information. Failure to provide documentation, in the manner and time required by the host campus, may mean that needed services cannot be provided.

Part D – Emergency Contact

Conditions of Placement & Authorization

National Student Exchange policies, procedures and student responsibilities are detailed in the NSE Student Guide and on the Student Section, "Policies and Procedures" at nse.org. I have read and understood these conditions and agree to abide by them.

Eligibility Prior to Exchange - I understand that my participation in the National Student Exchange is conditional upon my maintaining, at the end of the term prior to exchange, all eligibility requirements (academic, social, behavioral) as defined by NSE and my home and host campuses. If I fail to meet these requirements, I understand that my exchange will be cancelled.

Eligibility While on Exchange - I understand that my exchange may be terminated by either my home or host campus if I fail to comply with all eligibility standards, requirements, rules and regulations (academic, social, behavioral) of my home and host campuses. I also understand that my exchange may be terminated if I fail to remain enrolled as a full-time student at my host campus. Failure to remain full-time may affect my financial aid, housing, or ability to remain on exchange at my host campus.

Timely Completion of Forms - I understand that my participation in the National Student Exchange is contingent upon my returning all forms (application, registration, housing, etc.) and other materials which may be requested by my host campus by stated deadlines. Failure to do so may result in the cancellation of my placement.

Exchange Period - I understand that my exchange placement is limited to the period specified on PART B. An extension of a single term exchange will be considered only with the written approval of both my home and host NSE coordinators. Under no circumstances will the total of all my exchange periods exceed the equivalent of one calendar year. I further agree that if I cancel or shorten the duration of my exchange, I will notify in writing the NSE coordinators at both my home and host campuses. I understand that failure to so notify may have financial and/or enrollment consequences. I further understand that NSE is not a mechanism for transfer to my host campus nor is it a means to circumvent my host institution's requirements for determining residency for tuition purposes.

Course Approval and Course Access - I understand that it is my responsibility to develop, during the term prior to exchange, a flexible, written advising agreement with my home campus that will identify how coursework to be taken at the host campus will fit into my degree requirements at my home campus. I understand that any deviation from the written advising agreement must be approved in writing by my home campus. I further understand that course pre-requisites or co-requisites at the host campus must be met and that course registration at the host institution is based on the availability of offerings and cannot be guaranteed.

Tuition/Fees, Room/Meals, and Other Fees - I agree to pay tuition/fees in a timely manner and according to the payment plan (Host or Home) on which I have been placed. I also agree to pay room/meals to my host campus in a timely manner. I understand that failure to make full payment of all required fees or to resolve other debts to the home or host campus may result in the cancellation of any course registration and/or disenrollment at the host campus and upon return to my home campus. I understand that all financial obligations to my host and home campuses must be fulfilled prior to receiving transcripts from my host campus, re-enrolling at my home university, or receiving a transcript or diploma from my home campus.

Off-Campus Housing - I understand that on-campus housing at some NSE member universities is not guaranteed or may not be available. I understand that if I live off campus, I do so at my own discretion and risk.

Transcripts - I assume responsibility to request that an official transcript of the work attempted while on exchange be sent back to the office on the home campus designated by the home campus NSE coordinator.

Insurance - I understand that NSE strongly recommends that I have adequate health insurance for the time period of exchange, and it is my responsibility to ensure that I am adequately covered for the period and place of my exchange. I further understand that my home and/or host campus may require purchase of institutional health insurance or proof of coverage. I understand that I may also be required to pay a fee to utilize the health services at my host campus. I understand that it is my responsibility to ensure that automobile and personal property insurance covers me during the place and period of my exchange as appropriate.

Medical Matters - I will comply with any requirements for medical information relating to my participation in the exchange, including obtaining or documenting immunizations or vaccinations required by my home and/or host campuses.

Personal Health and Safety - I understand that NSE and my home and host campuses cannot guarantee my health and safety while on exchange. I am responsible for acting prudently and exercising caution and common sense at all times. In extreme weather, pandemic, or other emergency situations, I understand that it is my responsibility to follow the instructions provided by host university personnel. I agree that NSE as well as my home and host campuses are not responsible for any personal injury, death, and/or loss or damage to property suffered by me during my exchange, including periods of travel with, and independent of, the exchange program. NSE does not accept any responsibility for any loss, damage, or interruption of classes suffered as a result of weather, pandemic, strike or other causes beyond the control of its member colleges and universities.

Rules and Regulations - It is my responsibility to be informed about, and I agree to abide by, all rules, regulations, and policies of NSE and my home and host campuses governing my academic, financial, and social/behavioral status while on exchange. I understand that failure to conform to these rules and regulations may result in the termination of my exchange participation and that further disciplinary action may be taken by my host and home campuses. I also understand that it is my responsibility to inform myself about the local, state, territorial, or provincial laws and to conduct myself in a manner that complies with those laws.

Release of Information - I understand that the collection, retention, and dissemination of my records, and information about me is subject to federal regulations under the Family Rights and Privacy Act of 1974. This means that I am responsible for specifying persons or agents who may have access to my records. I, therefore, give permission, by signing this Placement Acceptance Form, to collect and release information to my home and host institutions and to the National Student Exchange as it is appropriate to my application for, and participation in, exchange including: letters of recommendation, transcripts, financial status with the campus, report of conduct, and medical/counseling records all for the purposes of exchange participation, continuation, or termination. I further agree that my home and host campuses may disclose to one another, to the National Student Exchange, and to my parents, legal guardian, or spouse any information which may impact my mental health or physical well-being while on exchange. (This information is available to the above stated parties from the time of placement until the receipt of the final official transcript by the home campus of the work attempted at the host campus.)

Hold-Harmless - I understand that my participation in the National Student Exchange is voluntary. I understand that the National Student Exchange does not make any warranties of any kind, expressed or implied, regarding NSE program participation, including perceived quality of the experience or services rendered. I further understand that the National Student Exchange assumes no responsibility and disclaims any liability for any injury, loss, damage, or expense (personal, academic, financial, or other) suffered by me by reason of my participation in this exchange program.

I affirm that the information above is complete, accurate, and true to the best of my knowledge. I have read this form, including the Conditions of Placement. I understand its contents, agree with its conditions, and acknowledge that I am signing it freely, voluntarily, and under no compulsion.

Digital Signature

March 28, 2026
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