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   LIFELONG LEARNING PROGRAMME/ERASMUS – ECTS   

STUDENT APPLICATION FORM

ACADEMIC YEAR: 20…/20…
FIELD OF STUDY: ………………………………………………
   (Photograph)   

This application should be completed in BLACK and BLOCK letters in order to be easily copied and/or telefaxed.

 SENDING INSTITUTION

Name and full address:
     ……………………………………………………………………………………………………………………
     ……………………………………………………………………………………………………………………
Departmental coordinator – name, telephone and fax numbers, e-mail:
     ………………………………………………………………………………………………………………………
Institutional coordinator – name, telephone and fax numbers, e-mail:
     ………………………………………………………………………………………………………………………



STUDENT’S PERSONAL DATA
(to be completed by the student applying)
Family name:  ……………… First name(s):  …………………
Sex:  …M/F… Nationality: ………………  ………………
Date of birth:  ………………  ………………  ………………
Place of birth:  ………………  ………………  ………………
e-mail address:  ………………  ………………  ………………
Current address:  ……………… Permanent address
(if different):
 ………………
Current address is valid until:  ………………  ………………  ………………
Tel. no (incl. country code nr.):  ………………  Tel. ………………  ………………

LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM
(in order of preference):
    Period of study    
Institution Country From To Duration
of stay
(months)
No.
of expected
ECTS credits
 1. …………………………   ………………………   ……………   ……………   ………………   ……………………… 
 2. …………………………   ………………………   ……………   ……………   ………………   ……………………… 
 3. …………………………   ………………………   ……………   ……………   ………………   ……………………… 


STUDENT APPLICATION FORM - PAGE 1
 Name of student: …………………………
 Sending institution :………………………… Country : …………………………
 Briefly state the reasons why you wish to study abroad:
     ………………………………………………………………………………………………
     ………………………………………………………………………………………………

  LANGUAGE COMPETENCE
  Note: A proof of knowledge of the receiving institution’s language of instruction should be submitted

 Mother tongue: ............. Language of instruction at home
institution (if different):
................ 
Other languages  I have sufficient knowledge 
 to follow lectures 
 I need some extra preparation 
YES NO YES NO
 ....................
 .....................
 .....................
 .....................

  WORK EXPERIENCE RELATED TO CURRENT STUDY   (if relevant)

  Work experience / position     Firm /organization     Dates     Country  
 .....................  .....................  .....................  .....................
 .....................  .....................  .....................  .....................
 .....................  .....................  .....................  .....................

  PREVIOUS AND CURRENT STUDY


Diploma/degree for which you are currently studying: ……………………………

Number of higher education study years prior to departure abroad: ……………………

Have you already been studying abroad ?   Yes    No
If Yes, when? at which institution ? …………………………………………………………

The attached Transcript of records includes full details of previous and current higher education study. Details not known at the time of application will be provided at a later stage.


Student’s Signature………………………………     Date:……………


 RECEIVING INSTITUTION

We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate’s Transcript of records.
The above-mentioned student is provisionally accepted at our institution
not accepted at our institution
Departmental coordinator’s signature Institutional coordinator’s signature
……………………………………………………………………………
  Date ……………… Date ………………



STUDENT APPLICATION FORM - PAGE 2