
ΠΑΝΕΠΙΣΤΗΜΙΟ ΠΕΙΡΑΙΩΣ
TΜΗΜΑ ΔΙΕΘΝΩΝ &
ΔΗΜΟΣΙΩΝ ΣΧΕΣΕΩΝ

|
PHOTO |
International Relations Office
APPLICATION FORM FOR EXCHANGE STUDENTS – STUDIES
ACADEMIC YEAR
STUDY ON THE BASIS OF:International Mobility Program
PLEASE FILL IN CLEARLY – USE CAPITALS IF FILLED OTHER THAN ELECTRONICALLY
Sending institution
|
Name: |
Full address: |
|
|
ERASMUS code: |
||
|
Departmental coordinator: |
Name: |
Fax: |
|
Telephone: |
Email: |
|
|
Institutional coordinator: |
Name: |
Fax: |
|
Telephone: |
Email: |
|
Student’s personal data (to be completed by the student applying)
|
Family name: |
|
|
First name(s): male female |
|
|
Date of birth (dd-mm-yyyy): |
Place of birth: |
|
Country of birth: |
Nationality: |
|
Passport number: |
Marital status: married single |
|
Current address: (any correspondence, including the letter of acceptance will be sent to this address): Street & number:
Postal code & city:
Country:
|
Permanent address (if different):
Street & number:
Postal code & city:
Country: |
|
telephone no: |
e-mail: |
Previous education
|
Level of study: Bachelor’s Master’s Doctoral studies |
|
For how many years have you been enrolled at home institution? |
|
How many semesters have you completed prior to your departure abroad? |
|
State briefly the reasons why you wish to study abroad.
|
For which field of study do you wish to be enrolled at the
|
Faculty: |
|
Field of study: |
For which study period do you wish to be enrolled?
Winter semester (October – January)
Spring semester (February – June) Whole academic year (October –June)
Other:
I hereby declare that all information provided in this application form and the enclosures is correct:
|
Date, place:
Student’s signature: |
Please return this application with the enclosures:
3 copies of the proposed Learning Agreement
Transcript of Record = i.e. an official list of courses you have attended so far at home university
English Language Requirement Form for Exchange Students – see below
Accommodation form (if university accommodation required)
A copy of your passport/ID
3 photographs 35mm x 45mm (3,5 cm x 4,5 cm)
to the following address:
International Relations Office
Dr. Christina Kontogoulidou,Head of IRO
80, Karaoli & Dimitriou Str., 18534
+ 30 210 414 2245, 2248 (tel)
+ 30 210 414 2347 (fax)
PLEASE NOTE: Only original applications will be processed. The application can be sent electronically, but the paper version has to follow as soon as possible.
ENGLISH LANGUAGE REQUIREMENT FORM FOR EXCHANGE STUDENTS
|
A good standard of
English is required to become an exchange student at the |
|
To follow courses offered in English, your English skills must as a minimum compare to the below description (min. level B2). You have to:
|
|
To be signed by the student:
|
|
|
I hereby confirm that: I have the above described English skills (min. level B2) I do NOT have the above described English skills |
|
|
Name of student:
|
|
|
Date:
|
Signature: |
|
To be signed by the home university:
|
|
|
We hereby confirm that: our student has the above described English skills (min. level B2) our student does NOT have the above described English skills |
|
|
Name of the signatory: |
|
|
Title of the signatory: |
|
|
Email of the signatory: |
|
|
Name of partner university: |
|
|
Date: |
Signature: Stamp |
RESERVATION FOR ACCOMMODATION
If you wish to get help from the
International Relations Office
80, Karaoli & Dimitriou Str., 18534
+ 30 210 414 2245, 2248 (tel)
+ 30 210 414 2347 (fax)
|
NAME AND SURNAME:
|
|
|
|
Sex (Male/ Female): M F |
|
Address: |
|
Phone number: |
|
|
|
Date of arrival (dd/mm/yyy): |
|
Date of departure (dd/mm/yyy): |
|
|
|
|
Student’s preferences:
|
|
|
|
Private accommodation: Location: |
|
|
Single room |
|
|
Double room |
|
|
Triple room |
|
|
|
|
|
Hotel room/Hostel room |
|
|
|
|
|
Monthly available amount of money for the rent: |
|
|
Special requirements or assistance: |
|
Signature: Place and date:
Please note: The