Application Form for Outgoing IKBU Students

I - PERSONAL INFORMATION
National ID No
Student ID No
Surname
Name (First / Middle)
Sex / Female Male
Date of Birth (Month/Day/Year) / //
Place of Birth
Citizenship(s)
Student with disabilities (Yes/No) / If yes, we invite you to disclose this information so that your needs can be addressed and you can apply for an additional grant in order to cover the extra costs which may occur during your Erasmus+ mobility.
Department / Program / /
Cycle / Vocational Bachelor Master PhD.
Semester
GPA (Grade Point Average)
Prior participation in
Erasmus Mobility Programs / Yes If Yes, Please specify the type and the year of mobility :
Study Internship - 20/20 Academic Year
No
ImportantNote :Studentshaverighttoattend Erasmus Mobility Programs (Study andInternship) withgrantonce (for 12 months in total) in everycycle (Vocational-Bachelor, Master, PhD.)
Contact Details
Postal / Home Address
Telephone (Home / Mobile) / /
E-mail(s) / ,
Whom would you like to be contacted in the case of an emergency?
Surname
Name (First / Middle)
Relation to the Applicant
Postal / Home Address
Telephone (Home / Mobile) / /
II - EDUCATION
Please list all educational institutions that you have attended. Begin with pre-university studies (including elementary and secondary education) and list the name of the university and department you are currently attending.
1 / Name of the Institution / City / Country / Date of Attendance
(From / To) / Year of Graduation
/
2 / /
3 / /
4 / /
5 / /
Explain briefly why you want to study abroad, and how this would contribute to your academic and career objectives:
III. INFORMATION ON YOUR STUDY PERIOD ABROAD
How long do you plan to participate in the Exchange / Erasmus Program abroad? / One Semester( Fall Spring)
Two Semesters
University preferences
1 / Country
Name of University
Name of Department at HostUniversity
Language of Instruction
2 / Country
Name of University
Name of Department at HostUniversity
Language of Instruction
3 / Country
Name of University
Name of Department at HostUniversity
Language of Instruction
Erasmus Program Coordinator :
Name of the Coordinator : Signature
______
For Graduate Students (if applicable) :
Name of the Thesis Advisor : Signature
______
Head of Department : Signature
______
Please indicate your language competence
Language / I am currently studying this language (Yes / No) / I have sufficient knowledge to follow lectures (Yes / No) / I would have sufficient knowledge to follow lectures if I had some extra preparation (Yes / No)
English
French
German
VI. APPROVAL OF THE APPLICANT
I, hereby confirm that all information in my application is complete and correct.
Name of the Applicant :
Signature : ______Date : //
Place :

Please hand in the completed application form to The INTERNATIONAL OFFICE.

Istanbul KemerburgazUniversity

International Office

Mahmutbey Campus, Block A, 11st Floor.