Acknowledgement of Receipt Form: Student Mobility Grant
ERASMUS+
TRAIN EESH IP S
This form must be filled in by every student receiving an Erasmus+ student mobility
grant for a traineeship. It will be returned to the appropriate National Agency.
Academic Year: 20 ….. / 20…...
Name of Student: ______________________________________________________
Date of Birth: _____________________
Home Institution:
National University of Ireland, Galway
Host Enterprise/Organisation:____________________________________________
Duration of traineeship: from _______________ until _____________________.
I acknowledge the receipt of the following Student Mobility Grant amount funded
through the Erasmus+ Programme.
Amount €
Signature* ______________________
Date _________
*You must print out this form and sign it; then you may scan and send it by e-mail if you wish. We
cannot accept forms where a name has simply been typed in the signature space, or where an image of
the signature has been cut and pasted. The signature must be an original, handwritten one. Please
print the form on one single page.
Please post the completed form to:
Gisèle Farrell, International Affairs Office, NUI Galway, Ireland
OR fax it to 00 353 91 494562
OR e-mail it as a pdf to erasmus-office@nuigalway.ie.