ERASMUS+ STUDENT MOBILITY
OUTGOING STUDENT APPLICATION
FOR ACADEMIC YEAR 2022 / 2023
This application should be completed in clear block capital letters and returned
before 17th March – for the winter semester, or summer semester or full academic year –
to the International Office, room 158
STUDENT’S PERSONAL DATA
Family name: First name (s):
Date of birth:
Place of Birth: Sex: Nationality:
Current address: Permanent address (if different):
Tel.: E-mail:
Current address is valid until:
PREVIOUS AND CURRENT STUDY
Grade Point Average (cumulative): Index number:
Field of study:
Expected study level during exchange: Current semester of study:
Have you already been studying abroad ? Yes No
If Yes, when ? at which institution ? what programme ?
LANGUAGE COMPETENCE
Mother tongue: Language of instruction at home institution (if different):
I would have sufficient
I am currently studying this I have sufficient knowledge to
Other languages knowledge to follow lectures if
language follow lectures
I had some extra preparation
yes no yes no yes no
W HERE W OULD YOU LIKE TO STUDY
(list of institutions in order of preference):
Period of study Duration of stay N° of expected
Institution (code) Country
from to (months) ECTS credits
4
WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
Type of work experience Firm/organisation Dates Country
Briefly state the reasons why you wish to study abroad ?
Do you wish to apply for a mobility grant to assist towards the additional costs of your study period abroad?
Yes No
Name of student:
Date: Signature:
Tutor’s recommendation (optional):
Tutor’s name:
Date: Signature:
ERASMUS+ STUDENT MOBILITY