Student Application Form s3
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:
………………. …………………………………….
Erasmus ID Code: ……………………………… Postal Address:
……………………..…………………………… / Name of contact person:
……………………………………………….
Phone: +…………………………………….
Fax: +…………………………………….
Academic Responsible at the University of Origin: ……………………………………….
Supervisor (if different):
…………………………..…………………….
PERSONAL INFORMATION
Family Name: …………………………………….
Sex: Male Female / First Name(s)…………..…………………… Citizenship: ………………………………..
Father's Name: …………………………………..
Father's Profession: ……………………………. / Mother's Name: …………………………….
Mother’s Maiden Surname: …………………………………………
Mother's Profession: ……………………...
Date of Birth (day/month/year):
…………………………….. …………. / Place of Birth (city and country) …………………………………………………
Passport Number: ………………………………
Permanent Address
Street: …………………………….…..No………..
ZIP Code:……………………..
City:…………………………………………………
Country: …………………………………………. / Date and Place of Issue:
…………………………………………….
E-mail (in clear block letters):
………………………………………
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: / /20Deadline to receive the form:
· 20 June for the fall semester
· 20 November for the spring semester