Erasmus Programme
Student mobility for study	

APPLICATION FORM - incoming
ACADEMIC YEAR 2010/2011
  (Photograph)

HOST ORGANIZATION: University of South Bohemia in České Budějovice

Faculty:                                                               Field of study: 

SENDING INSTITUTION
Name and full address: 
                                      
Erasmus ID code:         	
Faculty/Department coordinator – name, telephone and telefax number, e-mail

Institutional coordinator - name, telephone and telefax number, e-mail

STUDENT’S PERSONAL DATA (to be completed by the student applying)
Family name:	First name (s):	
Date of Birth:	Place of Birth:	
Sex:	Nationality:	
Current address:	Pernament address (if different):	

		
Tel.:	E-mail:	

Period of study	Duration of stay (month)	No. of expected ECTS credits	
from  	to			
WS: 29. 9. 2010 – 18. 2. 2011            SS: 21. 2. 2011 – 1. 7. 2011

Name of student:	

Briefly state the reasons why you wish to study abroad?

	

LANGUAGE COMPETENCE
Mother tongue:		
Other languages:	Level	
	□ excellent	□ good	□ satisfactory	□ poor	
	□ excellent	□ good	□ satisfactory	□ poor	
	□ excellent	□ good	□ satisfactory	□ poor	

WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
Type of work experience	Firm/organization	Dates	Country	
		from	to		

PREVIOUS AND CURRENT STUDY
Diploma/degree for which you are currently studying (Bc. Mgr. PhD.):  	
Number of higher education study years prior to departure abroad:	
Have you already been studying abroad?                Yes             No 	
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 provided be at a later stage.

Do you wish to apply for a 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 candidate’s Transcript of records.	
The above-mentioned student is	 provisionally accepted at our institution
 not accepted at our institution	
Stamp of university and Departmental /Institutional coordinator’s signature:

Date: