ECTS - EUROPEAN CREDIT TRANSFER SYSTEM

STUDENT APPLICATION FORM

ACADEMIC YEAR 20...../20.....

FIELD OF STUDY:.................................................

This application should be completed in BLACK in order to be easily copied and/or telefaxed.
SENDING INSTITUTION
Name and full address:
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Department coordinator - name, telephone and telefax numbers, e-mail box:
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Institutional coordinator - name, telephone and telefax numbers, e-mail box:
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STUDENT'S PERSONAL DATA (to be completed by student applying)
Family name:............................................ First name(s):...............................................
Date of Birth:........................................... ........................................................................
Sex:............... Nationality:........................
Place of birth:...........................................
Current address:...................................... Permanent address (if different):
........................................................................ ..............................................................................
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Current address is valid until:................
Tel.:...................................................... Tel.:................................................................
LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of
preference):
Institution Country Period of study Duration No. of expected ECTS
of stay credits
(months)
from to
1.
2.
3.
STUDENT APPLICATION FORM - summary
Name of student:..................................................................................................................

Sending institution:
..................................................................... Country:.......................................................

Briefly state the reasons why you wish to study abroad?

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LANGUAGE COMPETENCE
Mother language:.................. Language of instruction at home institution (if
diffrent):...................................................................
Other languages I am currently I have sufficient I would have sufficient
studying this knowledge to follow knowledge to follow
language lectures 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
............................................. ................................... ............................... ..............................
....................................... ............................. ........................... ........................
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 o No o
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.
Do you wish to apply for a mobility grant to assist towards the additional costs of your study period
abroad? YES o NO o
RECEIVING INSTITUTION
We hereby acknowledge receipt of the application, the proposed learning agreement and the
candidate's Transcript of records.
The above-mentioned study is o provisionally accepted at our institution
not accepted at our institution
o
Departmental coordinator's signature Institutional coordinator's signature
...................................................................... ................................................................
... Date:.......................................................
Date:.......................................................

ECTS - EUROPEAN CREDIT TRANSFER SYSTEM

LEARNING AGREEMENT
ACADEMIC YEAR 20...../20..... - FIELD OF STUDY:.........................................................
Name of student:...................................................................................................................
 Sending institution: Country:
............................................................................................ ................................................
DETAILS OF THE PROPOSED STUDY PROGRAMME ABROAD/LEARNING AGREEMENT
Receiving institution: Country:
............................................................................................ ................................................
Course unit code Course title (as indicated in the information Number of ECTS
(if any) package) credits
If necessary, continue this list on a separate sheet
and page no. of the
information package
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Student's signature
.................................................................................................. Date: .........................................
SENDING INSTITUTION
We confirm that this proposed programme of study/learning agreement is approved
Departmental coordinator's signature / Date: Institutional coordinator's signature/ Date:
.................................................................... .......................................................................

RECEIVING INSTITUTION
We confirm that this proposed programme of study/learning agreement is approved
Departmental coordinator's signature / Date: Institutional coordinator's signature /Date:
..................................................................... ..............................................................
CHANGES TO ORIGINAL PROPOSED STUDY PROGRAMME/LEARNING AGREEMENT
(to be filled in ONLY if appropriate)
Name of student:...................................................................................................................
Sending institution: Country:
........................................................................................ ...................................................

Course unit code Course unit title (as indicated in the information Deleted Added Number of
(if only) and page package) course course ECTS
no. of the unit unit credits
information
package
........................ ................................................................... o o
........................ ................................................................... o o
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Student's signature
....................................................................................... Date:............................................

SENDING INSTITUTION
We hereby confirm the above-listed changes to the initially agreed programme of study/learning
agreement are approved.
Departmental coordinator's signature Institutional coordinator's signature

...................................................................... ......................................................................
Date:............................................................. Date:.............................................................
RECEIVING INSTITUTION
We hereby confirm the above-listed changes to the initially agreed programme of study/learning
agreement are approved.
Departmental coordinator's signature Institutional coordinator's signature

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Date:............................................................. Date:.............................................................