EPLUS_UNISTRASI

Intensive Language Courses for 2017/2018 ERASMUS+ students in Italy

APPLICATION FORM


For any need concerning the online EPLUS_UNISTRASI application form, please contact eplus@unistrasi.it

STUDENT'S PERSONAL DATA
Family name (*)
First name(*)
Gender (*)
Date of Birth (*) / /  (day/month/year)
City of Birth (*)
Country of Birth (*)
Nationality (*)
Personal e-mail address (*)
Additional e-mail address

Due to the fact that all the communications concerning EPLUS_UNISTRASI courses will be given by email, we take no responsability for incorrect email addresses.
Please be sure to type in correctly your email address.

STUDENT'S HOME UNIVERSITY
Name (*)
Faculty/Department
Erasmus contact personName (*)
Email 1 (*)
Email 2
Email 3
Telephone
Fax
Type of Erasmus+ (*) Study Traineeship

ERASMUS+ HOST UNIVERSITY (in case of study)
CountryItalia
Name (*)
Faculty/Department
Erasmus+ contact personName (*)
Email (*)
Telephone
Fax

ERASMUS+ HOST ORGANISATION (in case of traineeship)
Name (*)
Contact personName (*)
City
Email (*)
Telephone
Fax

ERASMUS+ STUDY/TRAINEESHIP PERIOD
Number of months of Erasmus+ period (*) (number)
Starting date of Erasmus+ Period (*)// (day/month/year)
Main subject of studies (*)

LANGUAGE COMPETENCE IN ITALIAN
Level of competence (*)

Requested EPLUS courses
Periods (*) 8-31 January 2018 (80 hours - 8 ECTS - 350€)

5-28 February 2018 (80 hours - 8 ECTS - 350€)
IMPORTANT - Application must be sent by one month before the course starting date


I confirm that the information provided in this application is true and accurate. In case I have to withdraw from the course, I will inform Università per Stranieri di Siena as soon as possible.

Please be sure that you have your Erasmus+ student nomination letter ready to be attached just after submitting the application form.

(*) -> Compulsory field