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Universitt Salzburg Anmeldeformular/ErasmusApplication Form/Erasmus

Heimatuniversitt:

(Sending Institution)ECTS

Studienfach:(Field of Study)

Aademisches !ahr (Academic

year):

(E"#$%EA& C#E'IT T#A&SFE#

SSTE)

&achname (Family name): *orname (First name):

+e,urtsdatum ('ate of ,irth): Staat (Country):

Studienadresee (Current address):

Strasse- &r.. (St- num,er): Foto (%hotogra/h):

Stadt (City): %ostleit0ahl (1i/ code):

Telefonnr. u. *or2ahl (%hone 2ith /refi3):

eimatadresse (!ermanent address):

Strasse- &r. (St- num,er.):

Stadt (City): +eschlecht (Se3):

nnl () 4ei,l (F)

%ostleit0ahl (1i/ code): Staat (Country): Telefonnr. u. *or2ahl (%hone 2ith /refi3): Staats,5rgerschaft

(&ationality)

Sprac"#enntnisse ($anguage competence)% Studienzeit in Salzburg (dates of stud& in Salzburg)

"nterrichtss/rache an der Heimatuniversitt

(6an ua e of tution at our home universit )

utters/rache :

(other lan ua e)Ha,en Sie gen5gend 'eutschenntnisse7:

('o you have sufficient no2ledge of german )

!a

()

&ein

(&)

89rauchen Sie einen vor,ereitenden 'eutschurs7:

(I 2ould have sufficient no2ledge to follo2 lectures if I had some e3tra /re/aration)

!a

()

&ein

(&)

Studienzeit in Salzburg (dates of stud& in

Salzburg)

4intersemester(2inter term)

; Sommersemester(summer term)

;

'atum ('ate): "nterschrift des Erasmusstudenten (Student