Student Application Form s3

STUDENT APPLICATION FORM University of Macedonia UNIVERSITY OF MACEDONIA (G THESSALO02) 156 EGNATIA STR, GR-54636 THESSALONIKI, GREECE LLP/Erasmus Program Academic Year: 20…/20… HOME INSTITUTION Name of Institution: Name of contact person: ………………. ……………………………………. ………………………………………………. Erasmus ID Code: ……………………………… Phone: +……………………………………. Postal Address: Fax: +……………………………………. ……………………..…………………………… Academic Responsible at the University of Origin: ………………………………………. Supervisor (if different): …………………………..……………………. PERSONAL INFORMATION

Family Name: ……………………………………. First Name(s)…………..…………………… Sex: Male  Female  Citizenship: ……………………………….. Father's Name: ………………………………….. Mother's Name: ……………………………. Father's Profession: ……………………………. Mother’s Maiden Surname: ………………………………………… Mother's Profession: ……………………... Date of Birth (day/month/year): Place of Birth (city and country) …………………………….. …………. ………………………………………………… Date and Place of Issue: Passport Number: ……………………………… …………………………………………….

Permanent Address E-mail (in clear block letters): Street: …………………………….…..No……….. ……………………………………… ZIP Code:…………………….. City:………………………………………………… Country: …………………………………………. Phone (country code/area code/number) Mobile Phone: +…………………………………………… +…………………………………..

ACADEMIC BACKGROUND Department in home University ………………………………………………… Year/Semester of studies…………………………… Subject area of exchange ……………………………………………………….. List the courses that you wish to study 1)………………………………………. 2)……………………………………… 3)………………………………………. 4)………………………………………… LANGUAGE SKILLS Mother tongue: …………………….. …………. Knowledge of other languages:

A) …………………………………… (Limited Good Fluent ) B)……………………………………..(Limited Good Fluent ) C)……………………………………..(Limited Good Fluent ) INTENDED TERM OF ATTENDANCE (tick respectfully) 1o Term (September-February) 2o Term (February-June) Academic year Duration of stay (in months) ………….. Date of Arrival at University of Macedonia (approximately): ......

Do you wish to attend a free intensive Greek language course (Please tick appropriately) Yes  No Do you wish to arrange accommodation for you in a University apartment: Yes  No QUESTIONNAIRE How did you learn about University of Macedonia and the program you applied for? From Internet (write the exact site): ………………………………………………. From my home University, International Office: Yes  No From my home University (Other department): ……………………………….. Personal Recommendation: Yes  No Other, please specify: ……………………………………………………………………………………………….

STUDENTS WITH DISABILITIES

The University seeks information on a strictly confidential basis. The University of Macedonia will use this information in order to provide aids and services to students with disabilities so that they have access to all academic courses.

Do you need any special access or assistance?

Yes □ No □

(If yes, please provide brief details.)

AUDITION (Only for the Department of Music Science and Art)

The Department of Music Science and Art of the University of Macedonia requires you to send in a certified recording of your audition repertoire. Please fill in the following: I have included a certified* recording of my audition repertoire Yes No List of pieces performed on your recording: ...... *Please let the teacher of your main subject sign the recording to certify that the recording is your own performance.

APPLICANT’S SIGNATURE: DATE: / /20

Deadline to receive the form:  20 June for the fall semester  20 November for the spring semester