UNIVERSITÀ DEGLI STUDI DI CATANIA

Area delle Politiche Comunitarie e Internazionali

ECTS - EUROPEAN CREDIT TRANSFER SYSTEM

STUDENT APPLICATION FORM

ACADEMIC YEAR 2009/2010

FACULTY: ......

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

SENDING INSTITUTION (Istituzione inviante)
Name and full address:
UNIVERSITA’ DEGLI STUDI DI CATANIA (ICATANIA 01)
Piazza Università, 2 – 95100 Catania (Italy)
LLP Erasmus Office - name, telephone and telefax numbers, e-mail:

Dott.ssa CinziaTutino, tel. +39 095 7307972, fax. +39 095 7307964, e-mail:

Area coordinator - name, telephone and telefax numbers, e-mail box ......
...... ……………………………………………………………………………………………………………..

STUDENT’S PERSONAL DATA (Dati personali dello studente)

(to be completed by the student applying)

Family name: ...... …………
First name (s): ...... …..
Date of birth: ...... …………
Place of Birth: ...... …………... / Sex: ...... Nationality:......
Address: ...... …………………………
...... ………..
...... ………..
E-mail: ………………………………………………….
Tel.: ......
Mobile phone. …………………………………………..

INSTITUTION WHICH WILL RECEIVE THIS APPLICATION FORM:

(Istituzione che riceverà il presente modulo)

Institution code / Country / Period of study
from to / Duration of stay (months) / N° of expected ECTS credits
1...... / ...... / ...... / ...... / ...... / ......

LANGUAGE COMPETENCE (Competenze linguistiche del candidato)

Mother tongue: ...... ………………..
Other languages / Advanced / Intermediate / Beginner
…………………...
…………………...
…………………... / o
o
o / o
o
o / o
o
o
RECEIVING INSTITUTION (Istituzione di accoglienza)
We hereby acknowledge receipt of the application, the proposed learning agreement.
The above-mentioned student is o
o
Departmental coordinator’s signature
......
Date: ...... / provisionally accepted at our institution
not accepted at our institution
Institutional coordinator’s signature
......
Date ......

Sending Institution (Istituzione d’invio)

Area Coordinator Responsible (Surname and name in capital letters)
………………………………………………………………
Faculty Stamp:
Signature …………………………………………………..

Erasmus Officer signature Stamp:

…………………………………………..
Date ……………………….

N.B. Il presente modulo deve essere presentato all’Ufficio Relazioni Internazionali, debitamente compilato, entro un (1) mese dall’accettazione della borsa, specificando il periodo di studio altrimenti l’ufficio non potrà procedere alla spedizione via fax del modulo.