APPLICATION FOR STUDENT MOBILITY Obr. 107-1/2017 Please fill in the missing fields! Name and family name: Address: Telephone number: Email: Study program: Year of study: Name of the higher education institution: Exchange period: □ 3 months (Mark the squares) 6 months □ 3 – 12 months □ Knowledge of foreign English German languages: active passive active passive □ □ □ □ (Mark the squares) French Spanish active passive active passive □ □ □ □ Italian Other languages: active passive ______________ □ □ active passive □ □ Involvement in other activities that are related to your study: Type of mobility: clinical practice □ (Mark the squares) study □ combination of study and practice □ Your study/placements preferences: Student`s signature: Signature of the responsible person and his/her function: _________________________________________________________________________________ Place and date: _______________________ Stamp
APPLICATION FOR STUDENT MOBILITY Obr. 107-1/2017 Please fill in the missing fields! Name and family name: Address: Telephone number: Email: Study program: Year of study: Name of the higher education institution: Exchange period: (Mark the squares) □ 3 months □ 3 – 6 months □ 12 months Knowledge of foreign languages: (Mark the squares) English □ active □ passive German □ active □ passive French □ active □ passive Spanish □ active □ passive Italian □ active □ passive Other languages: ______________ □ active □ passive Involvement in other activities that are related to your study: Type of mobility: (Mark the squares) □ clinical practice □ study □ combination of study and practice Your study/placements preferences: Student`s signature: Signature of the responsible person and his/her function: _________________________________________________________________________________ Place and date: _______________________ Stamp
ABFHC_107_1_2017_Application_for_student_mobility.docx