Erasmus + International Credit
Mobility Application – Exchange with the University of Adelaide
Instructions to apply and fill in this form:
 Complete all applicable sections of the form fully and clearly.
 Information must be word-processed.
 Form must be completed and ALL documents must be submitted with the form in ONE
email (PDF format.)
 Complete applications must be submitted before the deadline.
You should attach the following supporting documents to your application:
 HEAR transcript to date (see www.gla.ac.uk/students/sset/transcripts/)
 Personal Statement, giving reason why you want to take part in the ERASMUS+
programme. Aspects of academic as well as personal development should be
addressed in the statement. The statement should not exceed 500 words.
Deadlines:
You can use this form to apply for Exchange starting in February 2016, July 2016 or both.
If you are applying for both options, you should submit your form by the earliest deadline.
Exchange to start in February 2016: The application form and all supporting documents must
be submitted by 21 October 2015 by email to mrio-erasmus+-adelaide@glasgow.ac.uk.
Exchange to start July 2016: The application form and all supporting documents must be
submitted by 4 December 2015 by email to mrio-erasmus+-adelaide@glasgow.ac.uk.
Incomplete applications will not be considered.
Personal Details:
1.
PERSONAL DETAILS
First name(s)
Last name(s)
Student number
Nationality
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YOUR COURSE OF STUDY AT THE UNIVERSITY OF GLASGOW
Career:
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Degree subject(s): If Joint Honours,
state both
Current Year of Study
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Erasmus + International Credit
Mobility Application – Exchange with the University of Adelaide
Proposed courses while abroad:
Are you applying for a semester-only or a full year
exchange? :
Semester only ☐ Full Year ☐ both☐
Using the course catalogue from the University of Adelaide, indicate below the courses you plan to take
abroad, the course reference and the number of credits they are worth. Continue on a separate page if
necessary.
Course Name (Abroad)
Course Reference
Number of
ECTS Credit
Semester
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Course
Name/reference you
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Uof G
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Financial Assessment
Applicants must outline below their budget plan for their time abroad. This section may play an
important part in the selection process. Applicants who demonstrate careful and thorough planning
increase their chances of being selected.
Tuition Fees: Choose an item.
If someone else pays your fees, please specify (e.g. SAAS; Student loan; etc.): Click here to enter text.
Please provide a budget for your time abroad:
Expense
Amount
Provide brief details that reflects your research of costs at
host institution(s)
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Erasmus + International Credit
Mobility Application – Exchange with the University of Adelaide
Accommodation:
Travel:
Subsistence:
Other (books, extracurricular activities,
etc)
TOTAL:
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How do you plan to meet expenses while abroad excluding any Erasmus grant funding?
Income type
Student Loan:
Scholarship/Grant/etc:
Parental/Guardian
contribution:
Personal Savings:
Paid work placement:
Any additional sources of
funding while abroad:
EXPECTED TOTAL:
Amount
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Any further information
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Widening participation
UK students: In the UK this will normally apply to students from households with an annual income of
£25,000 or less. Please attach the most up to date loan/grant letters in your possession at the time of
application as any means-tested funding will be evidenced here.
Were you, at the time of application to University, living in a priority postcode
Yes ☐ No☐
Yes ☐ No
which is regarded by the Scottish Government as being within the 40% most
deprived regions of the country, as categorised by the Scottish Index of Multiple
Deprivation (SIMD). This is sometimes referred to as "MD" or "MD40?
Did you attend a Widening Participation (WP) Partner School?
Yes ☐ No☐
Are you or have you lived in Care? :
Did you participating in a recognised pre-entry programme, such as Top-Up or
Summer School?
Yes ☐ No☐
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Erasmus + International Credit
Mobility Application – Exchange with the University of Adelaide
EU students (non UK): you should provide evidence of and information on your home country’s criteria
for disadvantage plus evidence of how your financial circumstances meet these criteria i.e. income
evidence for your household and confirmation of the make-up of your household. Original documents
and their translation in English should be submitted with explanatory notes or declarations as required.
Applications will be assessed on a case by case basis, based on the information and the documents you
provide with your application.
Students with support needs
This is not a compulsory section but this information helps us assess your circumstances and ensure
adequate support is provided during your experience abroad.
Do you have any additional support needs whilst abroad either learning support needs or linked to a
disability or medical condition?* Yes ☐ No☐
If Yes to either, please provide details below, including any specific arrangements or facilities required at
the host institution.
Have you already discussed your requirements with the Disability Services here at Glasgow? Yes ☐ No☐
Do you authorise us to share this information with the host in order to facilitate any academic or other
requirements? Yes ☐ No☐
*Note: Additional support from Erasmus+ may be available to support students with disabilities or exceptional
special needs. If you feel your mobility project would not be possible without additional financial support, please
attach details to your application. We will then contact you to discuss the application for additional grant support to
the National Agency in order to cover the supplementary costs.
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Erasmus + International Credit
Mobility Application – Exchange with the University of Adelaide
COORDINATOR APPROVAL
☐ I confirm that the student is a suitable candidate for the exchange with the University of Adelaide.
☐ I have reviewed and approved the student’s course choices at the University of Adelaide
Signature of Coordinator (a printed signature will be taken as binding as if an original
signature)
Date
1.
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DATA PROTECTION STATEMENT
The University holds, collects and processes information about its staff (current and former), applicants and potential
applicants, and for individuals who do not have a contract of employment for example, non-contracted payees,
Honorary and Associate Staff. The information (which includes personal data) may include images and personal,
academic, employment, financial, health and disability information. This information is used for various academic,
administrative, management, pastoral, and health and safety reasons.
These Applicants and Staff will be asked, as appropriate, to provide and confirm their personal data, employment,
and academic details with the University. By providing/confirming this information they consent to the University
holding, collecting and processing such information.
The information provided by, and relating to, Applicants and Staff is processed in accordance with the University’s
Notification with the Information Commissioner under the Data Protection Act 1998 (the “Act”). This Notification is a
public document and can be viewed at the Information Commissioner’s website (www.ico.gov.uk).
The information provided by, and relating to, Data Subjects may be disclosed to certain third parties in order to meet
a statutory obligation, in accordance with the University’s Notification, or in accordance with the terms of the Act.
Some of the information processed by the University is “sensitive personal data” (as defined in the Act); this includes
information on racial or ethnic origin, political opinions, religious or other beliefs, physical or mental health or
conditions (including disability), sexual orientation or criminal records.
2.
CHECKLIST:
☐ Erasmus+ application form completed
☐ HEAR transcript to date is attached
☐ Personal Statement is attached
☐ Coordinator has approved your exchange and course choices and signed the form
☐ Student agreement section of the form is signed and dated below – an electronic signature is
acceptable
☐ The submission deadline has not passed.
3.
STUDENT AGREEMENT
☐ I confirm that I have not accepted a place on another exchange programme.
☐ I am formally requesting to be considered for a place on the Erasmus + programme and the Erasmus +
grant.
☐ I certify that the information I have provided here is true and correct. I accept full responsibility for
the information I have provided on this form.
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Erasmus + International Credit
Mobility Application – Exchange with the University of Adelaide
☐ I agree to abide by the admissions requirements, rules and regulations of University of Glasgow for
the Erasmus+ International Credit Mobility programme.
Signature of Erasmus applicant (a printed signature will be taken as binding as if an
original signature)
Date
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