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APPLICATION FORM FOR ERASMUS+ STUDENT MOBILITY FOR STUDIES
MOBILITY FOR HIGHER EDUCATION
ACADEMIC YEAR 2016/2017
Kindly note that handwritten applications will not be accepted.
PERSONAL DATA
Last Name: ________________________________
First Name: ____________________________________
Date of Birth: ______________________________
Nationality: ________________________________
I.D. Card No/ Student reference number: ___________________________________
Home address: _________________________________________________________________________________
______________________________________________________________________________________________
Tel/Mobile: _____________________________ Course: _________________________________________________
Current Year: ___________________________ UoM Email: _____________________________________________
LANGUAGE COMPETENCE
Mother Tongue: ____________________________________________________
Other Languages:
_____________
A1
A2
B1
B2
C1
C2
_____________
A1
A2
B1
B2
C1
C2
_____________
A1
A2
B1
B2
C1
C2
_____________
A1
A2
B1
B2
C1
C2
Common European Framework of Reference for Languages see http://europass.cedefop.europa.eu/en/resources/european-language-levels-cefr
EQUITY AND INCLUSION
Do you have a disability/special needs*?
Are you registered with ACCESS?
□
Yes □
Yes
□
No □
No
PLACEMENT PREFERENCE
Kindly indicate in which partner institution you would like to follow your exchange:
The list of placements is available at: http://www.um.edu.mt/int-eu/erasmusplus/outgoing/placements
st
1 Preference: ________________________________________________
nd
2 Preference: ________________________________________________
rd
3 Preference: ________________________________________________
Is this the first application you have submitted for the Erasmus Programme? Yes
□
No
□
Signature in blue ink: ___________________________________
Date: _____________________________________
Funded with the support from the European Commission
Instructions to Applicants:
Kindly note that handwritten applications will not be accepted.
Please submit one original and a photocopy of the original application form, (FEMA and Faculty of Arts students are required to
submit two photocopies of the original application form).
Prior to completing the application form you are advised to consult your Head of Department/ Erasmus Academic Coordinator
regarding the choice of Universities and study units.
Application forms are to be submitted by Wednesday 24 February 2016 at the following address:
International & EU Office
Room 105
Administration Building
University of Malta
Late Application forms will not be accepted.
All personal information requested in this application form is treated as confidential.
Kindly ensure that upon submission of your application form, an acknowledgement of application receipt is provided to you.
Any queries related to this application form can be directed to the International & EU Office on tel no: 2340 2804/3416 from 1000hrs1200hrs, 1500hrs-1600hrs or via email: erasmus@um.edu.mt .
Equity and Inclusion
*A person with special needs is a potential participant whose individual physical, mental or health-related situation is such that his/her
participation in the project / mobility Action would not be possible without extra financial support. (Erasmus+ Programme Guide for
2016 version 2 p.44). In line with the discussion held with the European Union Programmes Agency (EUPA) a quota of 3% of the
allocated funding for approved mobilities shall be applied for students with a disability/special needs.
www.um.edu.mt/int-eu/erasmusplus/outgoing/equityandinclusion
European Language Competence
It is beneficial for the students to self-assess themselves in the language competence, so as to find a suitable University which will
cater for their Academic needs.
Some European Universities will offer tuition in their native language, (eg: France, Italy, Spain, Germany) therefore it would be
advisable for the students to check their competence level in that specific language, so as to be able to follow lectures and sit for
exams. Students are advised to check the University Key data sheets found here:
http://www.um.edu.mt/int-eu/erasmusplus/outgoing/keydatalist or you can contact us on: erasmus@um.edu.mt for more information.
Students may wish to refer to the online self-assessment tool, so as to gauge their language competence. The European Level- Self
Assessment Grid below is being provided for ease of reference
http://www.um.edu.mt/__data/assets/pdf_file/0011/209684/selfassessmentgrid.pdf
Students are notified that the level of language obtained through this online tool (Europass) will in no way affect the selection process
of the Erasmus+ beneficiaries.
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