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STUDENT-APPLICATION-FORM

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STUDENT-APPLICATION-FORM

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									   Università degli Studi di Udine

                                                 ERASMUS STUDIO APPLICATION FORM
                                                                                                                               (Photo)
ACADEMIC YEAR 2009/2010

FIELD OF STUDY: .........................................................

This application should be completed in BLACK in order to be easily copied and/or telefaxed.
SENDING INSTITUTION:                       UNIVERSITY OF UDINE – VIA PALLADIO, 8 – 33100 UDINE, ITALY
Departmental coordinator (docente coordinatore):                          name, telephone and telefax numbers, e-mail address.
.....................................................................................................................………………………………………….
.....................................................................................................................………………………………………….
Erasmus Institutional coordinator
Prof. ssa Franca Battigelli
Erasmus administrative coordinator
Claudia Schileo tel +39/0432/556221, fax +39/0432/556229 claudia.schileo@amm.uniud.it
STUDENT’S PERSONAL DATA (to be completed by the student applying)

Family name: ....................................................................…………………………………………….
First name(s): ...................................................................……………………………………………..
Sex:.......................   Nationality:..........................................
Date of birth: ...................................... Place of Birth: .................................……………………….
Permanent address:…………………………………………………………………………………………………
Current Tel.: ...................................................Current e-mail………………………………………….


ERASMUS STUDY PERIOD

Period to study at the host University……………………………………………...(n°of months)
The month of arrival at the host University …………………………………………………………………..

LANGUAGE COMPETENCE
 Mother tongue: ....…………………………... Language of instruction at home institution ITALIAN

   Other languages             I am currently studying                      I have sufficient       I would have sufficient knowledge to
                                    this language                         knowledge to follow         follow lectures if I had some extra
                                                                                lectures                          preparation
                                  yes                  no                   yes           no            yes                   No

 ...................                o                   o                     o           o              o                    O

 ..................                 o                   o                     o           o              o                    O




                                                                                                                                            1
WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
 Type of work experience    Firm/organisation                                                                     Dates                                    Country
 .................................…………                ............................………                 ..................……                .........................…….
 ..…………………                                            .............................……..               ..................……                .........................…….

CURRENT STUDY
 Diploma/degree for which you are currently studying:

 .................................................................................................................................................Number of University study
 years prior to departure abroad: ...............................
 Have you already been studying abroad ?                                                                  Yes o                    No o
 If Yes, when ? at which institution ?

 ..................................................................................................................................................
 (Please find here attached the Transcript of Records (certificato con gli esami sino ad ora sostenuti) released by the
 University of Udine)



Student’s signature………………………………………
Date…………………………………………….

                                                                       RECEIVING INSTITUTION
 We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate's Transcript of
 records.
 The above-mentioned student is                                                           o     provisionally accepted at our institution
                                                                                          o    not accepted at our institution

 Departmental coordinator’s signature                                                     Institutional coordinator’s signature

 ...................................................................                      ......................................................................

 Date ...........................................................                         Date: ………………..........................................




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