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Application Form
Erasmus Summer School 2013
Agros, Cyprus, 4 -25 August, 2013
Reconfiguring Values and Knowledge
for Sustainable Communities
5 ECTS
Please complete the Application Form and submit it, along with all supporting materials indicated
below, to your institutional coordinator
**NEW DEADLINE EXTENSION: Until June 11th 2013!**
(Institutional coordinators are listed at the end of this form)
Prerequisites
Eligible students must be enrolled in a MA or PhD program, or be entering the third or fourth year of
their undergraduate studies
Application Materials
Students applying for the Summer School are required to send in the following documents, completed in
full in English: (Please note, applicants may be asked to meet their institutional coordinator to discuss
their application materials further)
Please attach
photograph
 ... Application Form
 ... Short biographical note (50-100 words) or CV
 ... A Statement of Purpose (250-300 words) explaining why you want to attend
the Summer School
 ... Names of two referees, preferably academic teachers, who could
provide a letter of recommendation for you
 ... A copy of your passport page with your picture and data (only for Mykolas
Romeris University and Queen’s University students)
 ... A sample of your writing, e.g., project report or a paper (750-1,500 words)
 ... A copy of your transcript
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Personal Information
Last name: ....................................... First name(s): .................................. ........
Street address:
.................................................................................................................
Country:.............................. City:.............................. Postal Code:..................
Telephone numbers (home and mobile): .....................................................................
E-mail:......................................................alternative email:.............................
Date of birth (day/month/year): ......./...... /....... .  Male  Female
Country of birth: ............................... Citizenship:...............................................
Country of permanent residence: ...........................................................................
Passport Number:............................................ Issued by: ...................................
Date of Issue: ................................... Valid until :.............................................
Emergency contact:.........................................................................................
(Name, address, phone number, of the person we should contact in case of emergency)
Education
Name of University:..........................................................................................
Department:...................................................................................................
Level of study at the home university:
 Bachelor (year of studies............................)  Masters
 PhD
Experience/interests related to environmental studies or sustainable development
.................................................................................................................
.................................................................................................................
Professional objectives in relation to sustainable development and/or environmental studies
.................................................................................................................
.................................................................................................................
Title of graduate thesis, MA or PhD, if applicable:
References
Provide the names and institutional affiliations of the two referees, preferably your teachers
1. ..............................................................................................................
.................................................................................................................
2. ..............................................................................................................
.................................................................................................................
Languages
Students who are not native speakers of English should note that the Summer School lectures will be
conducted in English and some of the assignments must be completed in English. Therefore, please
indicate the type and level of course work you have already undertaken in English
.................................................................................................................
.................................................................................................................
Statement of Purpose: Attach a statement explaining why the Summer School Program
“Reconfiguring Values and Knowledge for Sustainable Communities” appeals to you and how it relates
to your academic and professional goals (maximum 250-300 words)
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RODON HOTEL RATES
Rodon Hotel (www.rodonhotel.com) The
Erasmus accommodation fund also provides
€380 towards your room and board expenses
during your 3-week stay. The student will be
responsible for any outstanding balance owed
to the hotel. Students should calculate their
financial costs depending on whether they
choose full board or half board, single room
(with bathroom) or double room (double room
with bathroom to be shared with another
student). Below are the rates for double
room/full board and half board.
To book your room, a Participation Fee of €200 is
required by June 14th. The Participation Fee will
be refunded only after the successful completion
of the first two weeks of the Program.
DOUBLE ROOM
Full board is €58/day for 21 days (including
bed, breakfast, lunch, and dinner), totaling
€1,218 - €380 (Erasmus accommodation grant)
leaving an outstanding balance of €838 to be
paid by the student.
For SINGLE ROOM add an extra €16 per day.
Required: Please indicate whether you
want to purchase half board or full board
DOUBLE ROOM
Half board at Rodon Hotel: I, the student
accept the Erasmus scholarship and will be
responsible for covering the difference of €586.
Full board at Rodon Hotel: I, the student
accept the Erasmus scholarship and will be
responsible for covering the difference of €838.
SINGLE ROOM
DOUBLE ROOM
Half board is €46/day for 21days (including
bed, breakfast, lunch OR dinner), totaling
€966 - €380 (Erasmus accommodation grant)
leaving an outstanding balance of €586 to be
paid by the student.
Half board at Rodon Hotel: I, the student,
accept the Erasmus scholarship and will be
responsible for covering the difference of €922.
Full board at Rodon Hotel: I, the student,
accept the Erasmus scholarship and will be
responsible for covering the difference of
€1,174.
NEW DEADLINE EXTENSION: UNTIL JUNE 11th, 2013
(New deadlines below apply only to new applicants.)
Students who have already submitted their application form must arrange for their
Participation Fee and airline ticket with their institutional coordinator before May 30th
If you are accepted into the program, you will be notified by email and/or phone. The Institutional
Coordinator will explain how to remit your Participation Fee via bank transfer or cash.
NEW! June 14th Your Participation Fee (€200) is due and must be received to secure your place in the
Summer School Program. Your Participation Fee will be applied towards your hotel room costs.
NEW! June 20th – For Queen’s University Belfast and Mykolas Romeris University students, electronic proof
of purchase and/or payment of your airline ticket must be received. Check with your Institutional Coordinator
for details. The Erasmus credit for airfares will be as follows: for UK students, €500; for Lithuania students,
€650. The cost of your ticket will be deducted from your accommodation costs. Your Participation Fee will be
returned to you upon successful completion of the IP, two weeks into the IP (August 19th).
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Please indicate if you are covered by valid health and accident insurance or hold a European Health
Insurance card_______YES_____________NO___________
Applicant’s Acknowledgement of Conditions
I have read the instructions regarding this application form and understand that my application will be
considered if I complete the required documentation.
I understand that the maximum the Erasmus travel fund allowance or my airfare is: €500 for a student from the
UK ; €650 for a student from Lithuania; and €100 (gas and/or taxi) for a student from Cyprus. If the airfare for
my round trip to Cyprus costs more than the above amount I will pay the difference.
Queen’s University Belfast (extended deadline applicants): I understand that by June 20th, I must prepay the
cost of the airfare to my coordinator. In addition, I will pay a €200 as Participation Fee which is refundable if I
meet the conditions required to successfully complete the IP. Upon successful completion of the initial two
weeks of the IP, the €200 Participation Fee will be returned or can be used to cover personal expenses at the
Rodon Hotel
Mykolas Romeris University Students: See your coordinator concerning payment/purchase of airfare
--Should I decide to cancel my participation in the IP program after paying for my airfare and submitting my
Participation Fee, I understand that I will receive no refund of my airfare and/or the Participation Fee.
I accept the Erasmus Accommodation Award of €380 which covers part of my accommodation expenses in a
double room shared with another student at Rodon Hotel, Agros in Cyprus, August 4th to August 25th. The
Erasmus Accommodation Award will be granted to me upon successful completion of the IP.
I understand that if I am accepted into the program, I am obligated to attend all program classes from August
4th to August 25th, 2013. I understand that participation in field trips and social and cultural events organized
with other students are obligatory. I further understand that any unpaid balance for personal expenses at Rodon
Hotel must be paid in full prior to the graduation ceremony, on Friday, August 23rd.
--Should I decide to withdraw from the program prior to August 25th, I understand that I will be responsible
for paying, in full, any unpaid balance towards my accommodation at the Rodon Hotel, Agros.
I understand that after successful completion of my coursework and the submission of a final evaluation report
at the end of the Summer School I will receive a certificate and a transcript from the University of Cyprus
indicating that I have earned 5 ECTS. My home Department of School will determine the manner in which
these ECTS are applied.
Signature of Applicant: ..........................................................................................................
............................ Date
, 2013
Institutional Coordinators
Anastasia Nikolopoulou, Associate Professor, Department of English Studies, School of Humanities, Coordinator
for University of Cyprus. Bldg M Kallipoleos 75, POB 20537, Nicosia, 1678. Email: nicocy@cytanet.com.cy,
nikolo10@ucy.ac.cy Tel: +357 22892101, cell: +357 99327235
Egle Bileviciute, Professor, Faculty of Law, Mykolas Romeris University, Coordinator for Mykolas Romeris
University. Room No.: IV-208. Email: eglek@mruni.lt. Tel: +370 5 271695, cell: +370 68649690
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M. Satish Kumar, Director, Queen’s University Belfast-India Initiative, Associate Professor, School of Geography,
Archaeology, and Palaeoecology, Coordinator for Queen’s University, Belfast. Email: erasmus.gap@qub.ac.uk Tel:
+44-02890973350