ACADEMIC YEAR |
20 |
/20 |
(photograph) |
FIELD OF STUDY: ……………………………………………. |
HOSTING INSTITUTION: |
Technological Educational Institution of Athens |
SEMESTER OF STUDIES ABROAD |
(WINTER/SPRING) |
FROM:……………………………. TO: …………………………………. |
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SENDING INSTITUTION |
Name and full address |
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Departmental co-ordinator – name, telephone and fax numbers, e-mail box: |
……………………….. |
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Institutional co-ordinator – name, telephone and fax numbers, e-mail box: |
…………………………. |
………………………………………………………………………………………………………………………… |
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STUDENTS PERSONAL DATA: (to be completed by the student applying) |
Family name |
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First name(s) |
…………………………………………………………………………… |
M/F |
……………. |
Date and place of birth |
…………………………………………………………………………………………… |
Current address: |
………………………………………. |
Permanent address (if different): |
…………… |
……………………………………….…………………… |
……………………………………….……………… |
……………………………………….…………………… |
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Current address is valid until: |
……………………………………….…………………………………………... |
Tel |
+ …………………………………………………... |
Mobile: |
+………………………………………….. |
E-mail: |
……………………………………….……………………………………….………………………… |
Briefly state the reasons why you wish to study abroad? |
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LANGUAGE COMPETENCE |
Mother tongue: |
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Language of instruction at home institution (if different) |
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Other languages |
I am currently studying this language |
I have sufficient knowledge to follow this lectures |
I would have sufficient knowledge to follow lectures if I had some extra preparation |
……………….. |
YES |
NO |
YES |
NO |
YES |
NO |
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WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant) |
Type of work experience |
Firm/organisation |
Dates |
Country |
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PREVIOUS AND CURRENT STUDY |
Diploma/degree for which you are currently studying: |
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Number of higher education study years prior to departure abroad: |
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Have you already been studying abroad? |
Yes ¨ No ¨ |
If Yes. when? At which Institution? |
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RECEIVING INSTITUTION |
We hereby acknowledge receipt of the application, the proposed learning agreement |
The above-mentioned student is ¨ accepted at our Institution |
¨ not accepted at our institution |
notes/remarks pertaining to learning agreement: |
Departmental co-ordinator’s signature: |
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Institutional co-ordinator’s signature: |
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Departmental co-ordinator’s name: |
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Institutional co-ordinator’s name: |
Dr.Georgios Panagiaris |
Date: |
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Date: |
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