Academic Exchange Program Impact Assessment
Please complete this form to help us assess the outcomes and experiences of your academic exchange participation.
Participant Name
*
First Name
Last Name
Email Address
*
example@example.com
Home Institution
*
Host Institution (Exchange Program)
*
Duration of Exchange (Start and End Dates)
*
Which type of program did you participate in?
*
Undergraduate Exchange
Graduate Exchange
Research Fellowship
Other
Please rate the following aspects of your exchange experience:
*
Rows
Very Poor
Poor
Average
Good
Excellent
Academic learning opportunities
1
2
3
4
5
Cultural immersion
6
7
8
9
10
Support from host institution
11
12
13
14
15
Personal growth
16
17
18
19
20
Language development
21
22
23
24
25
How would you rate your overall satisfaction with the exchange program?
*
1
2
3
4
5
What were the main challenges you faced during your exchange? (Select all that apply)
Language barrier
Cultural adjustment
Academic workload
Social integration
Financial issues
Other
Please share one significant way the exchange program impacted your academic or personal development.
*
Additional comments or suggestions to improve the exchange program:
Signature (Please sign below to confirm your responses)
*
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