ECTS_____ EUROPEAN CREDIT TRANSFER SYSTEM

STUDENT APPLICATION FORM

ACADEMIC YEAR 20...../20

FIELD OF STUDY :	

 

This application should be completed in BLACK in order to be easily copied and/or telefaxed.

SENDING INSTITUTION 
Name and full addres:
UNIVERSIDAD DEL PAIS VASCO/EUSKAL HERRIKO UNIBERTSITATEA
(THE UNIVERSITY OF THE BASQUE COUNTRY)
Departmental Coordinator: name/tel/fax, e-mail box:

Institutional Coordinator: name/tel/fax:

STUDENT'S PERSONAL DATA
 (To be completed by the student applying)
Family name:	First name(s):
Date of birth: 	
Sex: 	Nationality: Spanish
Place of birth:	
Current address: 		Permanent address (if diferent): 

		

Current address is valid until: 
Tel: 		Tel:

	
LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of preference):
Receiving institution	Country	Period of studies	Duration of stay	Number of
		from to	(months)	expected credits

1.					
2.
3
Page 1

Name of student:             
Sending institution: EUSKAL HERRIKO UNIBERTSITATEA  Country: SPAIN

Briefly state the reasons why you wish to study abroad?

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 knowledge to
	this language	to follow lectures	follow lecture if I had some extra preparation
	YES	NO	YES	NO	YES	NO

	 		 		 		

WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant):
Type of work experience	Firm/organisation	dates	country
............................................................................................................................................................................................................
............................................................................................................................................................................................................

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? at which institution?

The attached Transcript of records includes full details of previous and current higher education study.
Details not known at the time of application will be provided at a later stage.

Do you wish to apply for an ERASMUS ECTS mobility grant to assist towards the additional costs of your study period abroad? Yes   No 

RECEIVING INSTITUTION

We hereby acknowledge receipt of the application, the proposed learning agreement and the candidates’s Transcript of records.

The above -mentioned student is	provisionally accepted at our institution

	
	not accepted at our institution

Departmental coordinator’s signature	Instituional coordinator’s signature

Date:	Date: