ERASMUS STUDENT APPLICATION FORM

(Except for Newcastle Business School)

ACADEMIC YEAR:
FIELD OF STUDY:
ACTIVITY:
(studies, work placement, project)

Except for signatures/dates, please complete electronically (not handwritten).

SENDING INSTITUTION
Name and full
address: .............................................................................................................................................................
.
..............................................................................................................................................................
..............................................................................................................................................................
Department coordinator - name, telephone and fax numbers, e-mail
address ..............................................................................................................................................................
..............................................................................................................................................................
Signature: . Date:
Institutional coordinator - name, telephone and fax numbers, e-mail address
..............................................................................................................................................................
..............................................................................................................................................................
Signature: . Date:
STUDENTS PERSONAL DATA

(to be completed by the student applying)

Family
name: .................................................................
Date of birth: ............................................

First name
(s): ..........................................................................

Sex: ..............Nationality:..........................
Place of Birth: ............................................
Current
address: ...............................................................
..
.................................................................
.................................................................

Permanent address (if

different): ..........................................................................
.
...........................................................................
...........................................................................
...........................................................................
...........................................................................
Tel.: ..........................................................................

Current address is valid until:...................

Tel.:
E-mail:

PERIOD OF STAY AT HOST INSTITUTION

Name of host institution:
Erasmus application (2012)

From

To

Number of months

Name of
student: ..............................................................................................................................................................
Sending institution:
......................................................................................... Country: ..............................................................
LANGUAGE COMPETENCE
Mother tongue: ..................... Language of instruction at home institution (if different): ............................
Other languages

.........................
.........................
.........................

I am currently studying
this language

yes

I have sufficient
knowledge to follow
lectures

no

yes

no

I would have sufficient knowledge

to follow lectures if I had some
extra preparation

yes

no

DISABILITY/SPECIAL NEEDS
If you have a disability or special needs please enter an X in the box alongside
CRIMINAL CONVICTIONS
If you have any relevant criminal convictions please enter an X in the box alongside
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? and at which institution ? ..................................................................................................

Students signature: Date:
RECEIVING INSTITUTION
The above-mentioned student is

provisionally accepted at our institution

not accepted at our institution

School/Division coordinators signature

Institutional coordinators signature

....................................................................

...............................................................................

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

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

Please enclose:
Learning Agreement
Curriculum Vitae
Erasmus application (2012)

Transcript of Records (certificate of completed studies so far)

Copy of the personal details section of your passport

Personal Statement (1-2 page statement including reasons for wanting to spend an Erasmus period
abroad; past travel or study abroad experiences; any relevant work experience related to current study)
If you are applying to Fine Art or Design please enclose a CD of examples of your work.

Erasmus application (2012)