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KAUNAS UNIVERSITY OF TECHNOLOGY

APPLICATION FORM

MOBILITY SCHOLARSHIP

FOR EXCHANGE STUDIES UNDER BILATERAL AGREEMENTS

2015─2016 academic year

(please complete this form in BLOCK capitals)

I.  PERSONAL INFORMATION

First name(-s):
Family Name(-s):
Citizenship
Date of Birth: / Place of Birth:
Passport/ ID No / Valid from: till:
Country of Origin:
Current address in Kaunas
Address: ......
......
City......
Country......
Current address valid until: ......
E-mail: ......
Mob. tel.: ...... / Permanent address
Address:......
......
City......
Country......
Next of kin: ......
Mob. tel./tel.: (with area code) ......
......

II. ACADEMIC BACKGROUND

Your studies at Kaunas University of Technology
Faculty:
Study area:
Course:
Group:
Study level: / q  Bachelor studies / q  Master studies / q  PhD studies
Have you already studied abroad? / q  Yes / q  No
If yes, when?
At which institution, country?
Title of the programme:

III. KNOWLEDGE OF LANGUAGES

Please enter the evaluation from the Erasmus language test certificate received from the Centre of Foreign Languages, KTU, correspondingly: excellent, good, sufficient, poor. Also, please enter your self-evaluations of other foreign languages you know.

Language / Listening / Reading / Speaking / Writing

Would you agree to participate in exchange studies without the scholarship? oYes oNo

IV. PLANED EXCHANGE STUDIES

1) Please write your choices of the higher education institution (-s), where you would like to study (in order of preference):

1.
2.
3.

Language of planed studies: ......

2) Exchange study period: oAutumn semester 2015 oSpring semester 2016

3) Proposed duration of Exchange studies: From ...... till ………… in total…..months

4) Proposed study plan Information about institution‘s study plan can be found via internet. Get study plan approved by International Relations Coordinator at your faculty. Total amount of credits per semester 30 ECTS credits (1 KTU credit=1 ECTS credit).

1. Name of the Institution:
No. / Code and name of the course / ECTS/local credits
Total:
2. Name of the Institution:
No. / Code and name of the course / ECTS/local credits
Total:
3. Name of the Institution:
No. / Code and name of the course / ECTS/local credits
Total:
Information provided is correct and complete
Name, Surname / Signature / Date
Faculty International Relations Coordinator
Name, Surname / Signature / Date