University of Jaen

International Mobility Programmes International Relations Office Academic year

STUDENT EXCHANGE APPLICATION FORM

Type of Exchange Agreeement Personal details
First Name Identity Card / Passport no. Date of birth Nationality Home Address Home telephone Mobile telephone Email address

Applicant
Family Name Mobile telephone

Relationship (e.g. father) Telephone 1 Telephone 2

Language competence
Mother tongue

Espaol Espaol

Language of instruction at your home institution Spoken Spoken Spoken Spoken Other languages that you know: Written Next of Written

kin

Name Written Are you currently studying Spanish? Page 1 of 3

Written

Exchange Information
Name of your institution Degree / Course currently enrolled in Year you are studying Semester(s) you apply for Courses you want to take (Write the same courses that you have written in your Learning Agreement) Course Code* Course name (Write it in Spanish exactly as
*

This code is given in the Course Catalogue available www.ujaen.es/serv/vicord/secretariado/secplan/oferta_titulaciones.htm Write the names in full exactly as they appear in the Catalogue. at:

Page 2 of 3

Home institution information

Institution Full name in the original language: English translation University of Bio Bio Address Institutional Socrates-Erasmus Coordinator Name: Office telephone: +056 0412731261 Email: Signatures Student Institutional Coordinator Academic Coordinator Departmental / Academic Coordinator Name Office telephone Email
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Date Date Date

University of Jan Information

Institution Universidad de Jan Campus Las Lagunillas s/n 23071 Jan, Spain Name: Dr. Sebastin Bruque Cmara Office telephone: +34 953 21 21 94 Email: secrel@ujaen.es Name Jos Moyano Office telephone Email

jmoyano@ujaen.es

We hereby acknowledge receipt of the application, the proposed learning agreement and the candidates Transcript of Records. Institutional Socrates-Erasmus Coordinator Departmental / Academic Coordinator The above mentioned-student is Signatures Institutional Coordinator Academic Coordinator
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Date Date Page 3 of 3