LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in

Institution 
Country 
Period of study 
from to 
Duration of 
stay (months) 
NҮ of expected 
ECTS credits 
1............... 
2............... 
3............... 
........ 
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Name of student: 
............................................................. 
Sending institution: 
........................Country:............................. 
Briefly state the reasons why you wish to study abroad 
............................................................. 
............................................................. 
............................................................. 
LANGUAGE COMPETENCE 
Mother tongue: ................... Language of instruction at home institution (if different): 
............................................................. 
Other 
languages 
I am currently 
studying 
this 
language 
I 
have 
sufficient 
knowledge to follow 
lectures 
I would have sufficient knowledge 
to follow lectures if I had some 
extra preparation 
yes 
no 
yes 
no 
yes 
No 
........... 
........... 
........... 
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WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant) 
Type of work experience 
.................................. 
Firm/organisation 
.................................. 
Dates 
...................... 
Country 
.............................. 
PREVIOUS AND CURRENT STUDY 
Diploma/degree for which you are currently studying: 
............................................................. 
Number 
of 
higher 
education 
study 
years 
prior 
to 
departure 
abroad: 
............................................................. 
Have you already been studying abroad ? 
_ _
Yes |_| No |_| 

If Yes, when ? at which institution ? 
............................................................. 
The attached Transcript of records includes full details 
of previous and current higher education study. Details 
not known at the time of application will provided be at 
a later stage. 
Do you wish to apply for a mobility grant to assist towards 
the additional costs of your study period abroad? 
_
Yes |_| No |_| 
RECEIVING INSTITUTION 
We hereby acknowledge receipt of the application, theproposed learning agreement and the 
candidate’s Transcript ofrecords. 
The above-mentioned student is 
_ 
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_ 
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Departmental coordinator’s signature 
............................. 
Date: 
............................. 
provisionally accepted at our 
institution not accepted at our 
institution Institutional 
coordinator’s signature 
............................... 
Date 
............................... 

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