This form is exclusively for the Recruitment and International Office (RIO), Departmental ERASMUS Advisers and relevant Departmental/Faculty Exchange Co-ordinators who complete it with the relevant student(s). SECTION 1: STUDENTS COMPLETE BEFORE DEPARTURE (Return to Placement organiser) Student name Faculty Student registration Department no. Name of Host Name of Host University/employer Country Passport No. Mobile No. Permanent Home Address Contact Mailing Address & Email Address (if available) at Host University/employer) Emergency Home Contact for you when on placement (Name / Address / Telephone No ) a) Passport is held by student with an expiry date that exceeds the duration of the placement by 6 Yes No months, or Yes No b) Passport has been applied for and is pending Yes No Visa obtained or pending (if required). Yes No EHIC card obtained (for European travel only). Has separate travel/medical insurance been arranged for before and after the placement if staying abroad and also for any higher risk sports activities? (i.e. Sky-diving, snow -boarding etc.) Yes No (Note all students the University’s travel insurance will only cover the duration of the study period. – Students taking additional holidays before or after their study period must arrange separate insurance to cover that period). Issued November 2014
This form is exclusively for the Recruitment and International Office (RIO), Departmental ERASMUS Advisers and relevant Departmental/Faculty Exchange Co-ordinators who complete it with the relevant student(s). SECTION 1: STUDENTS COMPLETE BEFORE DEPARTURE (Return to Placement organiser) Student name Faculty Student registration no. Department Name of Host University/employer Name of Host Country Passport No. Mobile No. Permanent Home Address Contact Mailing Address & Email Address (if available) at Host University/employer) Emergency Home Contact for you when on placement (Name / Address / Telephone No ) a) Passport is held by student with an expiry date that exceeds the duration of the placement by 6 months, or b) Passport has been applied for and is pending Yes Yes No No Visa obtained or pending (if required). Yes No EHIC card obtained (for European travel only). Yes No Has separate travel/medical insurance been arranged for before and after the placement if staying abroad and also for any higher risk sports activities? (i.e. Sky-diving, snow -boarding etc.) (Note all students – the University’s travel insurance will only cover the duration of the study period. Students taking additional holidays before or after their study period must arrange separate insurance to cover that period). Yes No Issued November 2014