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Commission of the European Communities

LLP/ERASMUS
European Credit Transfer System (ECTS)

Student Application Form (20......./20........)

Field of Study:

1. ECTS sending Institution:

Name and full address of the Institution:

Departmental Coordinator:

Erasmus Institutional Coordinator: Tel./fax:...................................

E-mail: .....................................

2. Student’s personal data:

Family name: First name(s):
Date of birth: Sex: Nationality:
Place of birth:
Current address:
Permanent add. (if different):

Current telephone: Permanent telephone (if different):

The current address is valid until: Current fax / e-mail:

Number of higher education study years prior to departure abroad:

Diploma/degree for which you are currently studying:

Date when you began these studies:
Date when you expect to complete them:

Have you already been an exchange student? Yes q No q

If yes, when?, at which Institution? ............................................................................................................

3. Studies envisaged abroad:

List of Institution(s) that will receive this application form (in order of preference)

F06-PS6.9-01E/ed.1,rev.0 page 1
Receiving Institution Country Periods of studies Duration of stay Number of
from to months expected credits

F06-PS6.9-01E/ed.1,rev.0 page 2
Name of student:
Sending Institution:
Country:

I wish to take part in an intensive language preparation course

provided by the host Institution Yes No
I am available for summer course Yes No
Please send details Yes No

Language Competence:
Mother tongue: Language of instruction at home institution (if different):

Other languages: I am currently studying I have sufficient knowledge I would have sufficient
this language to follow lectures knowledge to follow lectures if
I had some extra preparation
Yes No Yes No Yes No
French
English
German

Work Experience related to current Study (if relevant):

Type of work experience Firm/Organization Dates Country
................................... …………………. …….... .............……….

................................... …………………. …….... .............……….

................................... …………………. …….... .............……….
................................... …………………. …….... .............……….

Current Study:
Name of Course
Course Code from Home Institution Information Package
See attached Transcript of Records

Do you receive funding from other sources? Yes No

If yes, which: ..................................................................................................................................................
Bank name, city: .............................................................................................................................................
account no.: ...................................................................................................................................................
BLZ: ...............................................................................................................................................................

F06-PS6.9-01E/ed.1,rev.0 page 3
Name of student:
Sending Institution: Country:

4. Details of Proposed Study Programme Abroad/Learning Agreement:

Period of study abroad from to
Total duration in months of my stay abroad:

Course code and page no. Course title (as indicated in the No. of credits
of the information package information package)

See attached Learning Agreement

NOTE: for technical reasons (e.g. timetable clashes) it may not be possible to take all the courses
proposed. It is important for the student to inform his/her home institution about the courses and
programme of study finally selected.

Student’s signature: ................................................... Date:

Sending Institution: I confirm that this application is approved.

Departmental Coordinator’s signature: ................................................. Date:

Erasmus Coordinator’s signature: …................................................... Date:

Decision from Receiving Institution

I hereby acknowledge receipt of this 3 page application form and the candidate’s Transcript of
Records.

The above mentioned student is: accepted at my institution

not accepted at my institution

Departmental Coordinator’s signature: .................................................. Date:

Erasmus Coordinator’s signature: ..................................................... Date:

F06-PS6.9-01E/ed.1,rev.0 page 4