PANTEION UNIVERSITY OF SOCIAL AND POLITICAL SCIENCES Department of International Relations and European Union LLP/ERASMUS APPLICATION FORM ACADEMIC YEAR …………………. To be completed and sent to Panteion by all incoming students no later than 15 th June for the winter semester no later than 15th November for the spring semester I am registering for: the first semester: from __ /__ /___ until __ /__ / ___ Months …………… (tick as appropriate) the second semester: from __ /__ /__ until __ /__ / ___ Months ………….. the whole year: from __ /__ /__ until __ /__ / ___ Months ………….. PANTEION Department of Registration: ______________________________________________ Academic Coordinator: __________________________________________________________ __ 1. PERSONAL DATA Surname(s):_____________________________ First name(s):_________________________ Date of Birth: __ /__ /____ Sex: Female Male Nationality: _________________________________________________ Home address: (please note that this is the address we will use to contact you before your departure) ___________________________________________________________________________ Postal Code: _______________ City: _____________________________________________ Country:_____________________________________________________________________ Telephone:__________________________ Mobile:__________________________________ Fax:___________________________ E-mail:________ _____________________________ Study level: Undergraduate Postgraduate Doctoral 2. ACADEMIC INFORMATION Sending Institution: ___________________________________________________________ Institutional Erasmus Code:______________________ City:___________________________ Name of current study programme: _______________________________________________ Institutional Socrates/Erasmus Coordinator Name: ______________________________________________________________________ Address: ____________________________________________________________________ Tel.: ___________________________________ Fax: ________________________________ E-mail: _____________________________________________________________________ Signature : __________________________________________________________________ Departmental Coordinator Name: ______________________________________________________________________ Address: ____________________________________________________________________ Department of International Relations and European Union 136, Syngrou Av. - Athens 176 71 – GREECE - tel: +30-210-9201483/4, fax: +30-210-9215767 e-mail: [email protected] Tel.: ___________________________________ Fax: ________________________________ E-mail: _____________________________________________________________________ Signature : __________________________________________________________________ Department of International Relations and European Union 136, Syngrou Av. - Athens 176 71 – GREECE - tel: +30-210-9201483/4, fax: +30-210-9215767 e-mail: [email protected] 3. Intention of Attending Greek Language: Yes No (tick as appropriate) 4. STATEMENT I hereby declare that the information I have submitted is true Signature of the applicant: _________________________________________________ Place and date: ________________________________________________ For your own convenience, make a copy of this form for yourself! Please return your application at : Panteion University, Department of International Relations and European Union , 136, Syngrou Avenue, 176 71, Athens, GREECE Fax: +30-210-9215767 Department of International Relations and European Union 136, Syngrou Av. - Athens 176 71 – GREECE - tel: +30-210-9201483/4, fax: +30-210-9215767 e-mail: [email protected] .