Academic year 2011-2012

Incoming Students

Erasmus APPLICATION FORM

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Students Personal Data Family name: ..First name: . Date of birth: Place of birth: Sex: Male Female Nationality: ... Passport or ID card number: .. Email: . Current Address: (valid until: / /200 ) Street + N: Postal Code: ..City: . Country: ..Tel: .Mobile Tel. Full name and phone no. of next of kin: . Permanent Address (if different) Street .N: .. Postal Code City: . Country: .Tel: Email: .. Mobile Telephone: .. Study Information Sending Institution Name: Institutional Code: .. City: .... Faculty: . Field of Study: Current Year of Study: Departmental Coordinator: Address: Tel.: Fax: ..Email: .. Signature . Date .. Institutional Erasmus Coordinator: Address: Tel.: .Fax: ..Email: . Signature ...Date: ...
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International Relations Office Mondragon Goi Eskola Politeknikoa Loramendi 4. Arrasate- Mondragon. 20500 Spain +34 943 794700 +34 943 791536 international@eps.mondragon.edu // www.eps.mondragon.edu

Receiving Institution Name of Institution: MONDRAGON UNIBERTSITATEA Faculty of Engineering Address: Loramendi , 4. 20.500 ARRASATE-MONDRAGON Country: SPAIN Erasmus Code: E MONDRAG01 Start of Study: End of Study: Study in Months Day Day Month Month Year Year

Institutional Erasmus Coordinator Joxe M Aizega. Tel.+34 943 712185 Fax:+34 943 712193 Email:jmaizega@mondragon.edu Faculty Erasmus Coordinator Gentzane Aldekoa Tel.+34 943 794700 Fax. +34 943 791536 Email: galdekoa@eps.mondragon.edu

International Relations Office Mondragon Goi Eskola Politeknikoa Loramendi 4. Arrasate- Mondragon. 20500 Spain +34 943 794700 +34 943 791536 international@eps.mondragon.edu // www.eps.mondragon.edu

Name and first name:

Briefly state the reasons why you wish to study at Mondragon Unibertsitatea:

Language knowledge: Mother tongue: Other Languages

I am currently studying this language I have sufficient knowledge to follow lectures
I would have sufficient knowledge if I had some extra preparation

Yes Spanish English French Basque Others:

No

Yes

No

Yes

No

Acceptance at Mondragon Unibertsitatea The above mentioned student is Departamental Coordinator Name Signature Date 0 Accepted at Mondragon Unibertsitatea 0 Not Accepted at Mondragon Unibertsitatea Faculty Coordinator Institutional Coordinator

International Relations Office Mondragon Goi Eskola Politeknikoa Loramendi 4. Arrasate- Mondragon. 20500 Spain +34 943 794700 +34 943 791536 international@eps.mondragon.edu // www.eps.mondragon.edu

Accommodation In case you are interested in our accommodation service, please let us know: Yes No If you answered positively, our student exchange office will contact you to inform about the lodging possibilities and economic conditions for them. Spanish language courses are offered during the academic year, 4 hours/week. Check list. Please, be careful and check that you are sending enclosed the following documents: 1234Application form Learning Agreement Transcript of Records Recommendation Letter

Once you are in Mondragon, you will be requested to handle these documents. Please, pay attention to the documents specified below: 1- Erasmus Grant holder certificate or proof of ability to sustain oneself financially for the academic year. 2- European Health Card copy, or any other private health insurance instead. 3- Liability insurance (insurance that covers any damage you may cause to third parts). 4- Student card from your Home University or a document stating that you are enrolled at your Home University specifying the period of registration. 5- Erasmus agreement signed with your University 6- A copy of identity card in force or passport. 7- 1 photograph.

International Relations Office Mondragon Goi Eskola Politeknikoa Loramendi 4. Arrasate- Mondragon. 20500 Spain +34 943 794700 +34 943 791536 international@eps.mondragon.edu // www.eps.mondragon.edu