ECTS application form TU/e Mechanical Engineering - Technische ...
ECTS application form TU/e Mechanical Engineering - Technische ...
ECTS application form TU/e Mechanical Engineering - Technische ...
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S<strong>TU</strong>DENT APPLICATION FORM EXCHANGE S<strong>TU</strong>DENTS<br />
Please complete this <strong>form</strong> using your PDF-reader before printing. Only if editing in your<br />
PDF-reader is impossible, print first and fill in by hand using black capital letters.<br />
S<strong>TU</strong>DENT’S PERSONAL DATA<br />
(to be completed by the student applying, data should be con<strong>form</strong> in<strong>form</strong>ation in passport)<br />
Family name (for married woman maiden<br />
name):<br />
Date of birth: / /20<br />
Sex: Male Female<br />
Place of birth:<br />
Country of birth:<br />
First name(s):<br />
Marital status: unmarried married<br />
Nationality:<br />
Current address:<br />
Permanent address (if different):<br />
Tel:<br />
Fax:<br />
E-mail:<br />
Tel:<br />
Fax:<br />
E-mail:<br />
SENDING INSTI<strong>TU</strong>TION (HOME UNIVERSITY)<br />
Name and full address:<br />
Departmental coordinator<br />
Name:<br />
Telephone:<br />
Fax:<br />
E-mail:<br />
Institutional coordinator<br />
Name:<br />
Telephone:<br />
Fax:<br />
E-mail:<br />
PREVIOUS AND CURRENT S<strong>TU</strong>DY<br />
Diploma/degree for which you are currently studying:<br />
Current field of study:<br />
PDF processed with CutePDF evaluation edition www.CutePDF.com
Number of higher education study years prior to departure abroad:<br />
Have you already been studying abroad? Yes No<br />
If Yes, when? At which institution?<br />
The attached Transcript of records includes full details of previous and current higher<br />
education study. Details not known at the time of <strong>application</strong> will be provided at a later<br />
stage.<br />
RECEIVING INSTI<strong>TU</strong>TION<br />
PREFERRED FIELD OF S<strong>TU</strong>DY AT <strong>TU</strong>E:<br />
Period of study<br />
Semester A:<br />
Semester B:<br />
N° of expected<br />
<strong>ECTS</strong> credits<br />
Preferred type of study during stay at <strong>TU</strong>/e:<br />
Courses<br />
Research project, please specify in which research area:<br />
Final project/thesis project, please specify in which research area:<br />
Internship, please specify in which research area:<br />
Briefly state the reasons why you wish to study abroad?<br />
NA<strong>TU</strong>RE OF VISIT AND GRANT<br />
What is the nature of your visit?<br />
Erasmus study (courses, traineeship, at the university, on the basis of a bilateral agreement)<br />
Erasmus student placements (in a company)<br />
Erasmus Mundus External Cooperation Window<br />
Within the scheme of another (non-Erasmus) bilateral agreement between <strong>TU</strong>/e and your<br />
institution<br />
Free mover<br />
Other, please specify:
LANGUAGE COMPETENCE<br />
Mother tongue:<br />
Language of instruction at home institution (if different):<br />
I have sufficient knowledge to follow lectures in: Yes No<br />
English<br />
(Dutch<br />
<br />
<br />
EER-Students:<br />
<br />
<br />
<br />
Non EER Students: <br />
<br />
<br />
<br />
WORK EXPERIENCE RELATED TO CURRENT S<strong>TU</strong>DY (if relevant) <br />
<br />
<br />
<br />
<br />
<br />
<br />
Please enclose:<br />
- copy of passport<br />
- transcript of records of previous and current higher education<br />
- learning agreement with proposed study program (if already known)<br />
- proof of sufficient mastery of the English language<br />
Please return this <strong>form</strong> to:
DECLARATION AND SIGNA<strong>TU</strong>RES<br />
SENDING INSTI<strong>TU</strong>TION<br />
Coordinator’s Name:<br />
Coordinator’s signature:<br />
Date:<br />
Stamp institution:<br />
RECEIVING INSTI<strong>TU</strong>TION: <strong>TU</strong>/e<br />
(to be completed by <strong>TU</strong>/e Department of )<br />
We hereby acknowledge receipt of the <strong>application</strong>, the candidate’s transcript of records and the<br />
learning agreement.<br />
The above-mentioned student is<br />
Accepted at our institution<br />
Not accepted at our institution<br />
Departmental coordinator’s signature:<br />
Date:<br />
Supervisor <strong>TU</strong>/e: _________________________________________________________<br />
Bachelor’s/Master’s program: _______________________________________________<br />
Period of study at <strong>TU</strong>/e: ____________________________________________________
Annex I<br />
Application <strong>form</strong> for Services (compulsory)<br />
Family name (for married woman maiden name):<br />
First name(s):<br />
Date of birth:<br />
Email:<br />
/ /<br />
Place of birth:<br />
Country of birth:<br />
Nationality:<br />
Sex: male female<br />
-----------------------------------------------------------------------------------------------------------------------------------<br />
Wishes to apply for:<br />
ACCOMMODATION (please answer the following questions)<br />
For more in<strong>form</strong>ation on housing for exchange students please visit www.tue.nl/housing<br />
Accommodation period for: Semester 1<br />
accommodation myself.<br />
Please note that the above mentioned period is the period of the rental agreement of the accommodation. This period may differ<br />
from the academic semester dates.<br />
The costs for accommodation are approx. 2000 to 2500 euro for one semester.<br />
Special remarks:<br />
Semester 2<br />
I do not want to make use of the accommodation service. I will arrange<br />
VISA 1 (please answer the following questions):<br />
Do you have a Dutch residence permit: Yes No<br />
(If you choose “no” and you need a VISA the <strong>TU</strong>/e will apply for it)<br />
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-<br />
Insurance (please answer the following questions)<br />
Do you have health insurance? 2 Yes No<br />
Do you have liability insurance? Yes No<br />
If you do not have insurance you need to contact the International Relations Office on arrival. We can<br />
arrange insurance for you with AON (www.students-insurance.eu)<br />
Undersigned by:<br />
Student<br />
Coordinator<br />
1 If you come to the Netherlands as an exchange student for more than 3 months you might need an MVV (visa) to enter the Netherlands.<br />
Students with the nationality of one of the following countries do not need to apply for a visa to enter the Netherlands: One of the countries<br />
of the European Union, Iceland, Norway, Liechtenstein, Switzerland, Monaco, Australia, New Zealand, Canada, the United States of<br />
America and Japan.<br />
2 The Netherlands has signed treaties regarding health insurance with the following countries: all of the EU member states, Norway, Iceland,<br />
Liechtenstein, Turkey, Morocco, most of the countries of <strong>form</strong>er Yugoslavia, Tunisia, Cape Verde Islands and Australia. If you are insured<br />
under the national health insurance scheme of one of these countries, your insurance company can provide you with an international<br />
declaration <strong>form</strong> called E-111 or E-128. Make sure to bring this <strong>form</strong> with you to the Netherlands.
Annex II<br />
Statement of home institution regarding mastery of the English language<br />
Family name (for married woman maiden name):<br />
First name(s):<br />
Date of birth: / / Place of birth:<br />
Email:<br />
Country of birth:<br />
Nationality:<br />
Sex: male female<br />
-----------------------------------------------------------------------------------------------------------------------------------<br />
Undersigned Coordinator confirms that the mentioned student has a sufficient knowledge of the<br />
English language comparable with:<br />
an original Academic IELTS score of at least 6.0 on average<br />
or TOEFL scores of at least 80 (Internet-based), 213 (computer-based) or 550 (paper-based).<br />
Name coordinator:<br />
Date:<br />
Signature coordinator<br />
Stamp institution<br />
Non EER students need to enclose one of the following language test with the <strong>application</strong> <strong>form</strong>s:<br />
- An original Academic IETLS test with a score of at least 6.5 on average;<br />
- An original TOEFL test with a score of at least 90 (internet based).