UNIVERSIDAD POLITÉCNICA DE CARTAGENA
SERVICIO DE RELACIONES INTERNACIONALES
PHOTOGRAPH
Plaza del Cronista Isidoro Valverde, s/n
Edificio "La Milagrosa"
30202 – Cartagena (ESPAÑA)
Tel.: + 34 968 325971 / + 34 968 325922
Fax: + 34 968 325972
E-mail: [email protected]
Web page: http://www.upct.es
APPLICATION FORM FOR ERASMUS STUDENTS
(Please complete this form in block letters or in type)
ACADEMIC YEAR:
_______/_______
STUDENT PERSONAL DATA
Family name:
First name:
Nationality:
Passport or ID Card number (*):
Sex:
Place of birth:
F
Date of birth:
M
Full present address (street, number, postal code, town, country):
Full permanent address (street, number, postal code, town, country):
Telephone (note country code):
Fax (note country code):
E-mail (if available):
(*): the same number must be used on every official document managed by the UPCT
INFORMATION ABOUT HOME INSTITUTION
Name:
Full address (street, number, postal code, town, country):
Telephone (note country code):
Fax (note country code):
E-mail:
Fax (note country code):
E-mail:
Institutional Erasmus Coordinator:
Telephone(note country code):
STUDENT PREVIOUS AND CURRENT STUDIES
Diploma/Degree for which you are currently studying:
First year of study:
Duration (years):
Expected date of conclusion:
Academic year you are studying now:
Faculty/School:
Field of study:
Have you already studied abroad?
Yes
If yes, when and where?
No
EDUCATIONAL PROGRAMME AT THE UNIVERSIDAD POLITÉCNICA DE CARTAGENA
Duration of study period in Cartagena: ______ months
from ___________ to _____________
Activity that you are going to carry out at the Universidad Politécnica de Cartagena:
Courses
Courses and Final Degree Project
Final Degree Project
Area of study:
Academic Erasmus Coordinator at home University:
Telephone (note country code):
Fax (note country code):
E-mail:
Academic Erasmus Coordinator at the Universidad Politécnica de Cartagena (if already known):
Telephone (note country code):
Fax (note country code):
E-mail:
ACCOMMODATION
Should you require accommodation in the University hall of residence?:
Yes
No
If yes, please send the accommodation form to the following e-mail: [email protected]
The prices can be found in the following link: http://www.upct.es/~ruac/normativa.html
Expected date of arrival:
Expected date of departure:
Any medical condition requiring treatment (allergies, diabetes, epilepsy, etc.)?
Comments:
There are other types of accommodation, such as sharing a flat with other students. No booking can be made for this kind of accommodation, but the
International Relations Office will provide students with useful addresses and information of private accommodation once they have arrived in
Cartagena.
LANGUAGE COMPETENCE
Mother tongue:
Level of Spanish:
Elementary
Intermediate
Advanced
The applicant hereby declares that all the information given in this form is correct and complete.
__________________________________________________
Signature
This application form should be returned to:
Universidad Politécnica de Cartagena
Servicio de Relaciones Internacionales
Plaza del Cronista Isidoro Valverde, s/n
Edificio "La Milagrosa"
30202 – Cartagena (MURCIA)
ESPAÑA
[email protected]
________/_________/__________
Date