LLP/Erasmus 2012-2013

The application form must be sent within the following deadlines: from March the 1st to June the 15th 2012 (study periods: first semester or whole academic year) or from September the 1st to November the 15th (study period: second semester).

PLEASE, CONSIDER THAT THE APPLICATION IS ELIGIBLE ONLY IF THE PARTNER INSTITUTION WILL CONFIRM IT OFFICIALLY !

Fields marked with an asterisk * are required.

* Field of Study:

* Subject area code:

* Sending institution:

* Duration of stay (in months)

* Semester:

I Semester
II Semester
Whole Academic Year

* Date of arrival (foreseen) - Date format:dd/mm/yyyy, for example 21/09/2006

* Date of departure (foreseen) - Date format:dd/mm/yyyy, for example 21/09/2006

* Family name

* First name (s)

* City of Birth

* Nation of Birth

* Date of Birth - Date format:dd/mm/yyyy, for example 21/09/1980

* Nationality

* Sex

* Email

* Address

* Zip

* City

* Current address nation

* Tel (current address)

Valid until

* Address

* Zip

* City

* Address nation

* Tel

Valid until

* Address

* Zip

* City

* Address nation

* Tel

Fax

Address

Zip

City

Tel

* Your mobile phone

* Contact person in case of emergency

Mother tongue

Language of instruction at home institution (if different):

Other Language

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

Diploma/degree for which you are currently studying

Number of higher education study years prior to departure abroad

Have you already been studying abroad?

If Yes, when

at which institution?

Course Unit Title

Number of ECTS credits

Department:

Family name:

First name:

Email:

Postal address:

Tel:

Fax:

Applicants' personal data are processed according to the Regulation (EC) No 45/2001 of the European Parliament and of the European Council of 18 December 2000 and to the Italian Government Legislative Decree n. 196/2003