E-mail this form to sco@du.se Application for an Erasmus+ stipend Student’s name Home address Date of birth/Personal number Dalarna University e-mail address Bank´s name Clearing no ( including IBAN/SWIFT if not a Swedish bank) Bank account number Receiving university or work place Period of stay Have you previously been on Erasmus exchange? From (date) until Totally months yes □ no□ Date Date and student´s signature: 1