APPLICATION FOR AN ADDITIONAL FOR THE MOBILITY OF HIGHER EDUCATION STUDENTS AND STAFF WITH SPECIAL NEEDS IN PROGRAMME COUNTRIES AND PARTNER COUNTRIES UNDER ERASMUS+ KEY ACTION 1 Please fill in and scan this application form and Annex 1, and together with scanned documents listed in item 9, email to the Education Exchanges Support Foundation at . The application form, 1, and the documents listed in item 9 must be sent to the email indicated above at least one month before leaving for studies, traineeship, or a teaching/learning assignment. PERSONAL DATA OF THE STUDENT / STAFF MEMBER 1. NAME, SURNAME 2. SENDING INSTITUTION 3. CYCLE (I, II, III) / POSITION 4. YEAR, FACULTY, DEPARTMENT DEGREE PROGRAMME (for students 5. only) 6. E-MAIL 7. MOBILE TEL. II. INFORMATION ABOUT ERASMUS+ MOBILITY Studies at a higher education institution abroad Traineeship in an enterprise abroad 1. TYPE OF MOBILITY Teaching assignment at a higher education institution learning assignment 2. RECEIVING INSTITUTION, COUNTRY TOTAL LENGTH OF STUDIES / 3. TRAINEESHIP, TEACHING / Months, days LEARNING ASSIGNMENT ABROAD DURATION OF STUDIES / 4. TRAINEESHIP, TEACHING / From (year-month-day) to (year-month-day) LEARNING ASSIGNMENT III. INFORMATION SPECIAL NEEDS 1. Please your special needs: 1. Disability type / illness
APPLICATION FOR AN ADDITIONAL FOR THE MOBILITY OF HIGHER EDUCATION STUDENTS AND STAFF WITH SPECIAL NEEDS IN PROGRAMME COUNTRIES AND PARTNER COUNTRIES UNDER ERASMUS+ KEY ACTION 1 Please fill in and scan this application form and Annex 1, and together with scanned documents listed in item 9, email to the Education Exchanges Support Foundation at . The application form, 1, and the documents listed in item 9 must be sent to the email indicated above at least one month before leaving for studies, traineeship, or a teaching/learning assignment. PERSONAL DATA OF THE STUDENT / STAFF MEMBER 1. NAME, SURNAME 2. SENDING INSTITUTION 3. CYCLE (I, II, III) / POSITION 4. YEAR, FACULTY, DEPARTMENT 5. DEGREE PROGRAMME (for students only) 6. E-MAIL 7. MOBILE TEL. II. INFORMATION ABOUT ERASMUS+ MOBILITY 1. TYPE OF MOBILITY Studies at a higher education institution abroad Traineeship in an enterprise abroad Teaching assignment at a higher education institution learning assignment 2. RECEIVING INSTITUTION, COUNTRY 3. TOTAL LENGTH OF STUDIES / TRAINEESHIP, TEACHING / LEARNING ASSIGNMENT ABROAD Months, days 4. DURATION OF STUDIES / TRAINEESHIP, TEACHING / LEARNING ASSIGNMENT From (year-month-day) to (year-month-day) III. INFORMATION SPECIAL NEEDS 1. Please your special needs: 1. Disability type / illness