KEY ACTION 1 MOBILITY OF INDIVIDUALS HIGHER EDUCATION STUDENTS ERASMUS +

KEY ACTION 1 MOBILITY OF INDIVIDUALS HIGHER EDUCATION STUDENTS ERASMUS + STUDENT APPLICATION FORM Poniższy wzór zawiera wypełnione 3 Application forms dla studenta, który wybrał trzy uczelnie partnerskie. W przypadku wyboru mniejszej ilość uczelni należy wypełnić odpowiednio mniejszą ilość Application form (Photograph) ACADEMIC YEAR 2017/2018 FIELD OF STUDY: Aerospace Engineering Power Engineering Automatic Control and Robotics Mechanika i Budowa Maszyn Lotnictwo i Kosmonautyka Nuclear Power Engineering Automatyka i Robotyka Energetyka Energetyka Jądrowa Inne (wpisz) This application should be completed in BLACK in order to be easily copied and/or telefaxed. SENDING INSTITUTION, FACULTY Name and full address: Warsaw University of Technology; Faculty of Power and Aeronautical Engineering Politechnika Warszawska, Wydział Mechaniczny Energetyki i Lotnictwa Tutor - name, telephone and telefax numbers, e-mail box : Prof. Elżbieta Jarzębowska (aerospace)- Faculty Erasmus Coordinator; :+ 48 22 234 60 29; elajarz@meil.pw.edu.pl dr inż. Nikołaj Uzunow (power & nuclear); Faculty Erasmus Coordinator; + 48 22 234 52 97 ; uzunow@itc.pw.edu.pl Dean - name, telephone and telefax numbers, e-mail box Prof. Janusz Frączek; dziekan@meil.pw.edu.pl tel. + 48 22 621 53 10 fax: +48 22 625 73 51 STUDENT S PERSONAL DATA (to be completed by the student applying) Family name: Kowalski... Date of birth:. 11/03/1989... Sex:. Male...Nationality:... Polish... Place of Birth:... Kraków... Current address:.ul. Tatrzańska 7 a pokój 102 00-742 Warszawa... First name (s): Jan Maciej... Permanent address (if different): ul. Erasmusa 3 mieszkania

Current address is valid until:... 16/05/2020... Tel.:...555-666-777... 4, 00-009 Kraków Tel.:... PREVIOUS PARTICIPATION IN ERASMUS Previous participation in Erasmus at the same level of study Study Cycle: FIRST SECOND THIRD YES/ NO Proszę wpisać uczelnię pierwszego wyboru Study (Number of months):. Placement (Number of months):... LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of preference): Institution Country Period of study from to 1. Univeristy of Genova 2.... 3........ Italy......... 01.10.2017 20.02.2018...... Duration of stay (months). 5.... N of expected credits (hours) 30ECTS/ 60 ECTS......... Name of student:... Jan Kowalski. Sending institution, Faculty: Faculty of Power and Aeronautical Engineering/ WUT/ Wydział Mechaniczny Energetyki i Lotnictwa/ Politechnika Warszawska Country: Poland/ Polska Briefly state the reasons why you wish to study abroad? I would like to extend my knowledge connected with the Automatic Control and Robotics programme and improve my knowledge of Italian. I know that the UNIGE offers a big range of topics connected with my specialization....

LANGUAGE COMPETENCE Mother tongue:.. Polish... Language of instruction at home institution (if different):... English... Other languages... English...... Italian...... French... I am currently studying this language I have sufficient knowledge to follow lectures I would have sufficient knowledge to follow lectures if I had some extra preparation yes no yes no yes no WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant) Type of work experience Firm/organization Dates Country Robot preparing specialist Firm ABC 01/07/2015-30/07/2015 Poland Assistant Firm DBC 01/08/2015-30/08/2015 Italy PREVIOUS AND CURRENT STUDY Diploma/degree for which you are currently studying:... Master in Engineering... Number of higher education study years prior to departure abroad:... Have you already been studying abroad? Yes No If Yes, when? at which institution?... The attached Transcript of records includes full details of previous and current higher education study. Details not known at the time of application will be provided at a later stage. Do you wish to apply for an ERASMUS + mobility grant to assist towards the additional costs of your study period abroad? Yes No RECEIVING INSTITUTION, Department: Univeristy of Genova/ Faculty of Engineering... We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate s Transcript of records. The above-mentioned student is Tutor s signature Date:... provisionally accepted at our institution not accepted at our institution Dean s signature Date :..

KEY ACTION 1 MOBILITY OF INDIVIDUALS HIGHER EDUCATION STUDENTS ERASMUS + STUDENT APPLICATION FORM Wypełnij w przypadku wybrania dodatkowej uczelni przyjmującej poza wcześniej wpisaną (docelowo można wybrać do 3 uczelni) tzw. uczelnia drugiego wyboru (Photograph) ACADEMIC YEAR 2017/2018 FIELD OF STUDY: Aerospace Engineering Power Engineering Automatic Control and Robotics Mechanika i Budowa Maszyn Lotnictwo i Kosmonautyka Nuclear Power Engineering Automatyka i Robotyka Energetyka Energetyka Jądrowa Inne (wpisz) This application should be completed in BLACK in order to be easily copied and/or telefaxed. SENDING INSTITUTION, FACULTY Name and full address: Warsaw University of Technology; Faculty of Power and Aeronautical Engineering Politechnika Warszawska, Wydział Mechaniczny Energetyki i Lotnictwa Tutor - name, telephone and telefax numbers, e-mail box : Prof. Elżbieta Jarzębowska (aerospace)- Faculty Erasmus Coordinator; :+ 48 22 234 60 29; elajarz@meil.pw.edu.pl dr inż. Nikołaj Uzunow (power & nuclear); Faculty Erasmus Coordinator; + 48 22 234 52 97 ; uzunow@itc.pw.edu.pl Dean - name, telephone and telefax numbers, e-mail box Prof. Janusz Frączek; dziekan@meil.pw.edu.pl tel. + 48 22 621 53 10 fax: +48 22 625 73 51 STUDENT S PERSONAL DATA (to be completed by the student applying) Family name: Kowalski... Date of birth:. 11/03/1989... Sex:. Male...Nationality:... Polish... Place of Birth:... Kraków... Current address:.ul. Tatrzańska 7 a pokój 102 00-742 Warszawa... First name (s): Jan Maciej... Permanent address (if different): ul. Erasmusa 3 mieszkania

Current address is valid until:... 16/05/2020... Tel.:...555-666-777... 4, 00-009 Kraków Tel.:... PREVIOUS PARTICIPATION IN ERASMUS Previous participation in Erasmus at the same level of study Study Cycle: FIRST SECOND THIRD YES/ NO Study (Number of months):. Proszę wpisać uczelnię drugiego wyboru Placement (Number of months):... LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of preference): Institution Country Period of study 1. Ecole Centrale de Nanates 2.... 3..... France/Francja......... from 01.10.2017...... to 20.02.2018...... Duration of stay (months). 5.... N of expected credits (hours) 30ECTS/ 60 ECTS......... Name of student:... Jan Kowalski. Sending institution, Faculty: Faculty of Power and Aeronautical Engineering/ WUT/ Wydział Mechaniczny Energetyki i Lotnictwa/ Politechnika Warszawska Country: Poland/ Polska Briefly state the reasons why you wish to study abroad? I would like to visit the Ecole Centrale de Nantes, because they have a English programme connected with my specialization. I have already found the supervisor there and I have contacted the teachers, who can help me to fulfill the declared list of subjects. I also know some French and I would like to improve my knowledge of this language....

LANGUAGE COMPETENCE Mother tongue:.. Polish... Language of instruction at home institution (if different):... English... Other languages... English...... Italian...... French... I am currently studying this language I have sufficient knowledge to follow lectures I would have sufficient knowledge to follow lectures if I had some extra preparation yes no yes no yes no WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant) Type of work experience Firm/organization Dates Country Robot preparing specialist Firm ABC 01/07/2015-30/07/2015 Poland Assistant Firm DBC 01/08/2015-30/08/2015 Italy PREVIOUS AND CURRENT STUDY Diploma/degree for which you are currently studying:... Master in Engineering... Number of higher education study years prior to departure abroad:... Have you already been studying abroad? Yes No If Yes, when? at which institution?... The attached Transcript of records includes full details of previous and current higher education study. Details not known at the time of application will be provided at a later stage. Do you wish to apply for an ERASMUS + mobility grant to assist towards the additional costs of your study period abroad? Yes No RECEIVING INSTITUTION, Department: Ecole Centrale de Nantes.... We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate s Transcript of records. The above-mentioned student is Tutor s signature Date:... provisionally accepted at our institution not accepted at our institution Dean s signature Date :..

KEY ACTION 1 MOBILITY OF INDIVIDUALS HIGHER EDUCATION STUDENTS ERASMUS + STUDENT APPLICATION FORM Wypełnij w przypadku wybrania dodatkowej uczelni przyjmującej poza wcześniej wpisaną (docelowo można wybrać do 3 uczelni) tzw. uczelnia trzeciego wyboru (Photograph) ACADEMIC YEAR 2017/2018 FIELD OF STUDY: Aerospace Engineering Power Engineering Automatic Control and Robotics Mechanika i Budowa Maszyn Lotnictwo i Kosmonautyka Nuclear Power Engineering Automatyka i Robotyka Energetyka Energetyka Jądrowa Inne (wpisz) This application should be completed in BLACK in order to be easily copied and/or telefaxed. SENDING INSTITUTION, FACULTY Name and full address: Warsaw University of Technology; Faculty of Power and Aeronautical Engineering Politechnika Warszawska, Wydział Mechaniczny Energetyki i Lotnictwa Tutor - name, telephone and telefax numbers, e-mail box : Prof. Elżbieta Jarzębowska (aerospace)- Faculty Erasmus Coordinator; :+ 48 22 234 60 29; elajarz@meil.pw.edu.pl dr inż. Nikołaj Uzunow (power & nuclear); Faculty Erasmus Coordinator; + 48 22 234 52 97 ; uzunow@itc.pw.edu.pl Dean - name, telephone and telefax numbers, e-mail box Prof. Janusz Frączek; dziekan@meil.pw.edu.pl tel. + 48 22 621 53 10 fax: +48 22 625 73 51 STUDENT S PERSONAL DATA (to be completed by the student applying) Family name: Kowalski... Date of birth:. 11/03/1989... Sex:. Male...Nationality:... Polish... Place of Birth:... Kraków... Current address:.ul. Tatrzańska 7 a pokój 102 00-742 Warszawa... First name (s): Jan Maciej... Permanent address (if different): ul. Erasmusa 3 mieszkania

Current address is valid until:... 16/05/2020... Tel.:...555-666-777... 4, 00-009 Kraków Tel.:... PREVIOUS PARTICIPATION IN ERASMUS Previous participation in Erasmus at the same level of study Study Cycle: FIRST SECOND THIRD YES/ NO Study (Number of months):. Proszę wpisać uczelnię trzeciego wyboru Placement (Number of months):... LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of preference): 1. RWTH Aachen Institution Country Period of study from to 2.... 3..... Niemcy......... 01.10.2017 20.02.2018...... Duration of stay (months). 5.... N of expected credits (hours) 30ECTS/ 60 ECTS......... Name of student:... Jan Kowalski. Sending institution, Faculty: Faculty of Power and Aeronautical Engineering/ WUT/ Wydział Mechaniczny Energetyki i Lotnictwa/ Politechnika Warszawska Country: Poland/ Polska Briefly state the reasons why you wish to study abroad? I would like to visit the RWTH Aachen, because they offer not only the special programme for Robotics, but also the possibility to take part in building a robot project with Italian students. My knowledge of Italian is sufficient to study and such opportunity can be a real challenge for me. I would not like to miss it....

LANGUAGE COMPETENCE Mother tongue:.. Polish... Language of instruction at home institution (if different):... English... Other languages... English...... Italian...... French... I am currently studying this language I have sufficient knowledge to follow lectures I would have sufficient knowledge to follow lectures if I had some extra preparation yes no yes no yes no WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant) Type of work experience Firm/organization Dates Country Robot preparing specialist Firm ABC 01/07/2015-30/07/2015 Poland Assistant Firm DBC 01/08/2015-30/08/2015 Italy PREVIOUS AND CURRENT STUDY Diploma/degree for which you are currently studying:... Master in Engineering... Number of higher education study years prior to departure abroad:... Have you already been studying abroad? Yes No If Yes, when? at which institution?... The attached Transcript of records includes full details of previous and current higher education study. Details not known at the time of application will be provided at a later stage. Do you wish to apply for an ERASMUS + mobility grant to assist towards the additional costs of your study period abroad? Yes No RECEIVING INSTITUTION, Department: RWTH Aachen.... We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate s Transcript of records. The above-mentioned student is Tutor s signature Date:... provisionally accepted at our institution not accepted at our institution Dean s signature Date :..