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Student Application Form
2020-2021 Autumn Semester
By submitting application form, applicant agrees for one’s information to be shared with other institutions that Šiauliai State College might refer to while processing with applicants exchange via Erasmus+ programme.
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* Indicates required question
Type of mobility
*
Erasmus+ studies
Erasmus+ traineeship
Faculty
*
At sending institution
Your answer
Field of study
*
Field of study (link to:
http://eqe.ge/res/docs/228085e.pdf
)
Your answer
Field of study
*
ISCED code (link to:
http://eqe.ge/res/docs/228085e.pdf
)
Your answer
Study programme
*
At sending institution
Your answer
STUDENT'S PERSONAL DATA
(to be completed by the student applying)
First name(s)
*
Your answer
Family name (surname)
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Place of birth
*
(city, country)
Your answer
Nationality
*
Your answer
Personal identification code
*
In case you do not have personal identification number, please indicate any other personal number provided for YOU by the Government, or if it is not applied to your situation - please insert "Not Available"
Your answer
Number of passport / identification card
*
Your answer
Date of validity
*
MM
/
DD
/
YYYY
Telephone number
*
(+XX XXXXXXXXXXXX, i.e. full telephone number including the country code)
Your answer
E-mail
*
Your answer
Gender
*
Female
Male
Prefer not to say
Student with disability
*
Yes
No
Home address
*
Your answer
In case of emergency
*
Name of the contact person, Phone no., E-mail address
Your answer
SENDING INSTITUTION
(Home institution)
Institution
*
Your answer
Address
*
Your answer
Departmental coordinator
*
Name, Family name (Surname), telephone, fax, e-mail
Your answer
Institutional coordinator
*
Name, Family name (surname), telephone, fax, e-mail
Your answer
Website
*
Your answer
APPLICATION TO ŠIAULIAI STATE COLLEGE
Beginning of studies / traineeship
*
MM
/
DD
/
YYYY
Ending of studies / traineeship
*
MM
/
DD
/
YYYY
Number of expected ECTS credits
*
Your answer
LANGUAGE COMPETENCE
Mother tongue
*
Your answer
English
*
No knowledge
A1
A2
B1
B2
C1
C2
Russian
*
No knowledge
A1
A2
B1
B2
C1
C2
Other languages
*
Your answer
WORK EXPERIENCE RELATED TO YOUR STUDIES
If relevant
Type of work experience
If relevant
Your answer
Institution / Company
If relevant
Your answer
Date of start
If relevant
MM
/
DD
/
YYYY
Date of end
If relevant
MM
/
DD
/
YYYY
PREVIOUS AND CURRENT STUDIES
Diploma / degree for which you are currently studying
*
Your answer
Number of higher education study years prior to departure abroad
*
Your answer
Have you already been studying abroad
*
Yes
No
If yes, when? Which institution?
Period of mobility, institution, country
Your answer
ACCOMMODATION
All students will be accommodated without additional registration in Šiauliai State College Dormitory, address: M. k. Čiurlionio 20, Šiauliai
Accommodation required
*
Yes
No
Date of arrival to Šiauliai
In case you marked YES in a previous question
MM
/
DD
/
YYYY
Date of departure from Šiauliai
In case you marked YES in a previous question
MM
/
DD
/
YYYY
ERASMUS+ EXPERIENCE
Please provide some additional information on why you chose Erasmus+ Exchange programme
Briefly state the reasons why you decided to go on Erasmus+ studies / traineeship
*
Your answer
Why did you decide to come to Šiauliai State College?
*
Your answer
Attachments
Please send your photo, copy of your passport / Identification card, LA (if completed), other documents necessary to the following e-mail:
g.zdanaviciene@svako.lt
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