Request for International Agreement
Request for International Agreement
York International
I. AGREEMENT PROPONENT
Please note that Agreement Proponent will be responsible for the provision of international activity updates once the agreement proposal is approved, and will be contacted by the York International accordingly.
A. FACULTY MEMBER (PROPONENT)
Faculty Member (Agreement Proponent) Name
Faculty Member (Agreement Proponent) Name
*
Title
First
Last
Suffix
Position
*
Department
*
Faculty
*
School of the Arts, Media, Performance & Design
Faculty of Education
Faculty of Environmental Studies
Glendon College
Faculty of Graduate Studies
Faculty of Health
Lassonde School of Engineering
Faculty of Liberal Arts & Professional Studies
Osgoode Hall Law School
Schulich School of Business
Faculty of Science
Phone
Phone
*
-
###
-
###
####
Email of Agreement Proponent
*
B. FACULTY AGREEMENT/PROGRAM CONTACT
Faculty Agreement/Program Contact Name
Faculty Agreement/Program Contact Name
*
First
Last
Position
*
Email of program coordinator
*
Phone
Phone
*
-
###
-
###
####
II. PROPOSED INTERNATIONAL PARTNER
Name of Institution and Country
*
A. ACADEMIC PARTNER
Faculty Member's Name
Faculty Member's Name
*
Title
First
Last
Suffix
Position
*
Department and Faculty
*
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Canada
Australia
Netherlands
France
Germany
-------
Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
Gabon
Gambia
Georgia
Ghana
Greece
Grenada
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Phone
*
Email
*
B. INTERNATIONAL OFFICE
Name of International Agreement Coordinator at Proposed Partner
Name of International Agreement Coordinator at Proposed Partner
*
First
Last
Position and Title
*
Department Name
*
Address
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Canada
Australia
Netherlands
France
Germany
-------
Afghanistan
Albania
Algeria
Andorra
Antigua and Barbuda
Argentina
Armenia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
Gabon
Gambia
Georgia
Ghana
Greece
Grenada
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Country
Phone
*
Email
*
III. OBJECTIVES AND RATIONALE
How will the proposed partnership contribute to your Faculty's priorities?
*
IV. DESCRIPTION OF ACTIVITIES
STUDENT MOBILITY
• What type of mobility program (exchange, internship or research)?
• Program Start & End Dates
• Number of Student Participants
• Location of activities
FACULTY MOBILITY
• Teaching or Research
• Program Start & End Dates
• Number of Faculty Participants; would students be involved?
• Projected outcomes (lectures, publications, funding proposal, etc.)
• Location of activities
Provide details of your proposed activities according to the information outlined above. List current activities with the proposed partner (if applicable). 1000 characters including spaces.
*
V. RESOURCES
Potential Funding source(s) to support proposed activities. List both international and external sources as applicable (YorkU/students will pay/scholarships/grants/government, etc).
Amount in CAD$:
Describe administrative supports available at your Faculty, as applicable (coordination, promotions, orientations, pre-departure training, finance, etc).
VI. FACULTY DEAN'S SUPPORT
Request Approved by
Signature:
Name and Last Name:
Date:
THE FOLLOWING SECTIONS ARE FOR YORK INTERNATIONAL ONLY.
VII. AGREEMENT REQUEST ASSESSMENT
Agreement requests are reviewed by York International.
Reviewed by:
HELEN BALDERAMA
Associate Director, International Partnerships and Programs (helencb@yorku.ca)
Date:
Recommended to the Provost by:
VINITHA GENGATHARAN
Executive Director, York International
(vinithag@yorku.ca)
Date:
VIII. TYPE OF AGREEMENT
A. Collaborative Agreement
B. Student Exchange Protocol
C. Summer Institute Protocol
D. Visiting Non-Exchange Student Protocol
E. Other type of agreement: ________________________________
F. Agreement not required
G.
Sponsored Research and Research Grant Agreements
are coordinated by the Vice-President Research and Innovation Office.
AFTER SUBMISSION OF THE FORM
You will receive a copy of the Request for Agreement Form you completed by email. Please PRINT and have it signed by your Dean. After securing the Dean's signature, send the Form by email to the York International at yorkintl@yorku.ca