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Application form for applicants of
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UNIVERSITY OF LODZ
ERASMUS+CREDIT MOBILITY 2015/2016
| PERSONAL INFORMATION | |||
| First Name | Last Name | ||
| Date of Birth | City of Birth | ||
| Country of Birth | Gender |  Male
 Female
| |
| Passport Number (expires) | E-mail Address | ||
| Telephone | Mobile Phone | ||
| Averaged grade | Language competences |
| PERMANENT ADDRESS | |||
| Street and number | City | ||
| Postal Code | State/Province | ||
| Country |
| PERMANENT ADDRESS FOR CORRESPONDENCE IF DIFFERENT FROM ABOVE | |||
| Street and number | City | ||
| Postal Code | State/Province | ||
| Country |
| LEVEL OF STUDIES | |||
| Name of Home University | Faculty | ||
| Bachelor/Master/PhD | State/Province | ||
| Country | Semester of study | ||
| Last Degree Obtained | I was grantee of Erasmus Mundus Programme*[1] | No
Yes
If yes for how long………………
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| Start Date of Studies | Date of awarding institution |
| LANGUAGE PROFICIENCY | |||
| Language | English | Skills | |
| Official certificates |
| Applicant’s Signature: Date: Year Month Day |
[1] If you have benefited from Erasmus Mundus scholarship for more than or equal to 7 months in total, you are not eligible to apply for Credit Mobility programme. If you have been selected for Erasmus Mundus scholarship for the period of 5 or 6 months you can apply for Credit Mobility. However, preference will be given to the applicant who has never benefited from an Erasmus Mundus scholarship.