“NEREUS” Student Application Form
Intensive Course, Malta, April 2017
Partner Institution:
THIS SECTION FOR ALL STUDENTS
PERSONAL INFORMATION
1. First name:
2. Last name:
3. Date of birth (e.g. 03-Feb-1995):
4. Sex (M/F):
5. Place of birth (e.g. City, Country):
6. Phone No:
7. Cell-phone:
9. Native language:
8. e-mail:
if other please specify
10. English language proficiency:
11. How and when did you first hear about the NEREUS Intensive Course?
THIS SECTION FOR UNDERGRADUATE STUDENTS ONLY
12. Faculty/Department:
13. Semester:
14. Average Grades
Telecommunications
Multimedia
Informatics
Networks
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THIS SECTION FOR POSTGRADUATE STUDENTS ONLY
15. Postgraduate Programme:
16. Faculty/Department:
17. Semester:
18. Specialisation/Division:
19. Average Grades
Telecommunications
Multimedia
Informatics
Networks
I certify that I have completed this application form myself and that the information I have given is correct. I understand
that I will have to provide all the necessary documents upon request.
Date (e.g. 03-Feb-1995):
Signature
When completed and signed, your application should be e-mailed to your Institution’s Contact Person.
Applications deadline is the 3rd of March 2017. Admission notifications will be issued by the end of March 2017.
For additional information, you may contact us at:
Telephone: +30 2810 379828
E-mail: pallis[at]pasiphae.eu
Web Site: http://www.nereus-erasmus.eu
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