Student’s personal data
(to be completed by the student applying)
| Family name:............................................................. Date of birth:............................................................. Sex:............................................................. Nationality:.......................................... Place of Birth:............................................... Current address:............................................ ............................................................. ............................................................. ............................................................. Current address is valid until:............ ………………………………………. Tel.:............................................................. | First name (s):................................................................. Permanent address (if different):...................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... Tel.:....................................................................... |
LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of preference):
| Institution | Country | Period of study from to | Duration of stay (months) | N° of expected ECTS credits | |
| 1................................ 2................................ 3................................ | ................. ................ ................. | .......... .......... .......... | ......... ......... ......... | ............... ............... ............... | ................................. ................................. ................................. |
| Name of student:........................................................................................................................................ Sending institution:................................................................ Country:....................................................................................................................................... |
| Briefly state the reasons why you wish to study abroad? ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................ |
LANGUAGE COMPETENCE
| Mother tongue:................... Language of instruction at home institution (if different): ........................................................................................................................................ | ||||||
| Other languages | I am currently studying this language | I have sufficient knowledge to follow lectures | I would have sufficient knowledge to follow lectures if I had some extra preparation | |||
| yes | no | yes | no | yes | No | |
| ...................... ...................... ...................... | o o o | o o o | o o o | o o o | o o o | o o o |
WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
| Type of work experience .................................... .................................... | Firm/organisation ................................... ................................... | Dates ...................... ...................... | Country ............................... ............................... |
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