ERASMUS+

(photo)

STUDENT MOBILITY PROPOSAL
ENROLMENT FORM
ACADEMIC YEAR	………… / ……...
ANNO ACCADEMICO

FIELD OF STUDY (ISCED code): .............................................................................
CODICE ISCED

This application should be completed in BLACK in order to be easily copied and/or telefaxed.
Si prega di compilare questa domanda in NERO per facilitarne la copiatura e/o la trasmissione via fax.n.b.: SCRIVERE IN stampatello o a macchina
HOME INSTITUTION	CODE: ...................................................	
Name and full address:..................................................................................................................................	
...................................................................................................................................	
.........................................................................................................................................................……	
Departmental coordinator of the programme:..................................................................................................	
telephone: ...........................................	telefax: ........................................e-mail:.......................................	
Institutional coordinator of the programme:......................................................................................................	
telephone : ......................................telefax : ................................... e-mail:.................................................	
COORDINATOR’S SIGNATURE	STAMP OF THE HOME INSTITUTION or Erasmus Office	
……………………………………...	…………………………………………………………………….	
(APPLICATION NOT ACCEPTED IF MISSING)	
STUDENT’S PERSONAL DATA	Registration N.: ..................................................	
Family name: ..........................................	First name(s): ........................................................ Sex:...........	
Cognome	Nome	Sesso	
Date of birth: ...............................	Place of birth: ................................. Nationality:...................................	
Data di nascita	Luogo di nascita	Cittadinanza	
Current address: ........................................................  Permanent address (if different): ............................	
...................................................................................  .................................................................................	
...........................................................................  ................................................……............................	
Tel.: ...........................................................................  e-mail.:..........................................................................	

Host Institution
Istituzione ospitante

UNIVERSITA’ di FIRENZE

School: ………………………… Erasmus coordinator of the pro- gramme: …………………….	
Country
Paese

Italy	Period of study
periodo

from (da)	to (a)

.................	................	Duration of stay (months)

Durata del sog- giorno (mesi)

.............................	expected ECTS credits
crediti ECTS previsti

............................	
RECEIVING INSTITUTION	NOT to be filled in by the applicant!
We hereby acknowledge receipt of the application	The above-mentioned student is
Confermiamo con la presente di aver ricevuto la domanda	Lo studente summenzionato provisionally accepted at our institution.		not accepted at our institution. provvisoriamente accettato/a presso la nostra istituzione.	non è accettato presso la nostra istituzione

Erasmus School delegate	Decentralized Student Office
Il delegato Erasmus	Uff. Servizi alla Didattica e agli Studenti di Polo
Signature: ………………………………	STAMP
Date: …………………………………….	Date: .......................................	
DATA FOR THE ENROLMENT:	To be filled in ONLY after arrival
Date of beginning of the study period at the University of Florence: ............................................................

Erasmus coordinator of the programme or Erasmus delegate
Signature: ………………………………	STAMP	Date: …………………………………….:	

Name of student: ............................................................	Registration N°: ......................................
Nome e cognome dello studente	N°di matricola
Home institution:..............................................................................	Country : .....................................
Istituzione di origine	Paese
Main reasons why I wish to study abroad:
Principali motivi dello studio all’estero
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
If necessary, continue on a separate sheet	
CURRENT AND PREVIOUS STUDY
STUDI ATTUALI E PRECEDENTI
Iscritto(a) al Corso di laurea/diploma in
Diploma/degree for which I am currently studying: ......................................................................................
Durata legale del corso
Duration of course: .........  years	Years of study prior to departure abroad : .....................................

I have already been studying abroad.	Yes	No
Precedenti soggiorni di studio all’estero
If Yes, when? ...........................
Se si, quando?
At which institution?......................................................................................
Presso quale istituzione?

I have benefited of Erasmus status before:	Yes	No
Ho beneficiato dello status di studente Erasmus in precedenza:	
WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
ESPERIENZE DI LAVORO (se rilevanti ai fini degli studi intrapresi)

Type of work experience	Company / organization	dates	country
Tipo di lavoro svolto	Ditta / Ente	periodo	paese

………………………………..	……………………………………..	…………	………………………
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………………………………..	……………………………………..	…………	………………………	

O R I G I N A L E

		

	

S E G R E T E R I A

LANGUAGE COMPETENCE

Livello di conoscenza
proficiency
Languages
Lingue straniere	
Mother tongue
Lingua madre	
Excellent
Ottima	
Good
Buona	
Fair
Media	
Italiano					
English					
Français					
Deutsch					
Español					
Other: .........................					
Other: .........................					

CONOSCENZA LINGUISTICA
D I

F I R E N Z E

Language of instruction at home institution (only if different from mother tongue) …………………………….
Lingua di insegnamento nell’università di origine (solo se diversa dalla lingua madre)

ERASMUS+
ECTS - EUROPEAN CREDIT TRANSFER SYSTEM (if adopted)

LEARNING AGREEMENT
ACCORDO DIDATTICO
ACADEMIC YEAR	..../....	FIELD OF STUDY (ISCED code):.............................................
ANNO ACCADEMICO	CODICE ISCED
O  Name of student: ............................................................	Registration N°: ......................................
R   Nome e cognome dello studente	N°di matricola
I	Home institution:..............................................................................	Country : .....................................
G  Istituzione di origine	Paese
I	Host institution:	FIRENZE 01	Country: ITALY
N  Istituzione ospitante	Paese
A   School: ……………………………………………………………………
L
E	Facoltà
STUDY PROGRAMME

ECTS Code, if any	Course Unit
Insegnamento	Y / S Annual, se- mestral,	ECTS Cred- its
crediti ECTS	

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Total expected credits	……………	

PROGRAMMA DI STUDIO
P E R

L A

S E G R E T E R I A

Student’s signature : .........................................................................
Firma dello studente

If necessary, continue on a separate sheet
Se necessario, continuare su un foglio separato

 		HOME INSTITUTION	ACCORDO DIDATTICO
ISTITUZIONE DI ORIGINE	LEARNING AGREEMENT
We confirm that this proposed programme of study is approved.
Per approvazione del programma di studio proposto
Erasmus Institutional/Departmental coordinator	Responsible academic tutor
Coordinatore Erasmus	Responsabile accademico
Name (nome): .............................................................	Name (nome): ..............................................................
Signature (firma): ....................................................... Signature (firma): .......................................................	
	HOST INSTITUTION (FIRENZE 01)	LEARNING AGREEMENT
ISTITUZIONE OSPITANTE	ACCORDO DIDATTICO
We confirm that this proposed programme of study is approved.
Per approvazione del programma di studio proposto	FIRENZE, ...................................................
Erasmus coordinator of the programme or
Erasmus delegate:	.......................................	..................................................
Name (nome)	Signature (firma)	

ERASMUS+ ACADEMIC YEAR	....../......
LEARNING AGREEMENT (2)
ACCORDO DIDATTICO (2)

O  Name of student: ............................................................	Registration N°: ......................................
R   Nome e cognome dello studente	N°di matricola
I	Home institution:..............................................................................	Country : .....................................
G  Istituzione di origine	Paese
I	Host institution:	FIRENZE 01	Country: ITALY
N  Istituzione ospitante	Paese
A   School: ……………………………………………………………………
L
E	Facoltà

CHANGES TO ORIGINAL STUDY PROGRAMME
CAMBIAMENTI DEL PROGRAMMA DI STUDIO ORIGINARIO

ECTS Code, if any	
Course Unit
Insegnamento	deleted	added course unit insegnamenti
cancellati	aggiunti	ECTS
Credits

crediti ECTS	

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(to be filled in ONLY if appropriate)	(compilare SOLO se del caso)

P E R

L A

	

Firma dello studente

If necessary, continue on a separate sheet.
Se necessario, continuare su un foglio separato.

Student’s signature : ...................................................................................

HOME INSTITUTION	LEARNING AGREEMENT
ISTITUZIONE DI ORIGINE	ACCORDO DIDATTICO
We confirm that this proposed programme of study is approved.
Per approvazione del programma di studio proposto
Erasmus Institutional/Departmental coordinator	Responsible academic tutor Coordinatore Erasmus	Responsabile accademico  Name (nome): .............................................................	Name (nome):
..............................................................
Signature (firma): ....................................................... Signature (firma): .....................................................
FIRENZE, ...................................................

HOST INSTITUTION	ACCORDO DIDATTICO
ISTITUZIONE OSPITANTE	LEARNING AGREEMENT
We confirm that this proposed programme of study is approved.
Per approvazione del programma di studio proposto	FIRENZE,............................................
Erasmus coordinator of the programme or …………………………..	…………………………… Erasmus delegate	Name (nome)		Signature (firma)

S E G R E T E R I A