SOCRATES  /  ERASMUS  /  TEMPUS / ALFA
INTERUNIVERSITY COOPERATION AGREEMENTS

STUDENT MOBILITY PROPOSAL
ENROLMENT FORM
ACADEMIC YEAR   ………… / ……...
ANNO ACCADEMICO

FIELD OF STUDY: .............................................................................................
AREA DISCIPLINARE	

(photo)	

This application should be completed in BLACK in order to be easily copied and/or telefaxed.
Si prega di compilare questa domanda in NERO per facilitarne la copiatura e/o la trasmissione via fax.n.b.: SCRIVERE IN stampatello o a macchina
ORIGINALE

PER	HOME INSTITUTION                                                                     CODE: ...................................................
Name and full address:..................................................................................................................................
                                            ...................................................................................................................................
                                            .........................................................................................................................................................……
Departmental coordinator of the programme:..................................................................................................
telephone: ...........................................    telefax: ........................................e-mail:.......................................
Institutional coordinator of the programme:......................................................................................................
telephone : ......................................telefax : ................................... e-mail :.................................................
COORDINATOR’S SIGNATURE                  STAMP OF THE HOME INSTITUTION or SOCRATES OFFICE                          ……………………………………...                 …………………………………………………………………….

                                                                                  (APPLICATION NOT ACCEPTED IF MISSING)
	
	STUDENT’S PERSONAL DATA 	Registration N.: ..................................................
Family name: ..........................................	First name(s): ........................................................ Sex:...........
Cognome	Nome	Sesso
Date of birth: ...............................	Place of birth: ................................. Nationality:...................................
Data di nascita	Luogo di nascita	Cittadinanza
Current address: ........................................................  Permanent address (if different): ............................
...................................................................................  .................................................................................
...........................................................................  ................................................……............................
Tel.: ...........................................................................  e-mail.:..........................................................................	
SOCRATES	
Host Institution
Istituzione ospitante

UNIVERSITA’ di FIRENZE

Faculty: …………………………
Socrates coordinator of the programme: …………………….	
Country
Paese  

Italy	Period of study
periodo

   from (da)          to (a)  

.................             ................	Duration of stay (months)

Durata del soggiorno (mesi)

.............................	expected ECTS credits
crediti ECTS
previsti

............................	
F
IRENZE	RECEIVING INSTITUTION                                                                 NOT to be filled in by the applicant!
We hereby acknowledge receipt of the application 		 The above-mentioned student is
Confermiamo con la presente di aver ricevuto la domanda	                 Lo studente summenzionato
        provisionally accepted at our institution.                   not accepted at our institution.
                   provvisoriamente accettato/a presso la nostra istituzione.       non è accettato presso la nostra istituzione

SOCRATES Faculty delegate	  Decentralized Student Office
Il delegato Socrates	  Uff. Servizi alla Didattica e agli Studenti di Polo 	 
Signature: ………………………………    STAMP
Date: …………………………………….	Date: .......................................	
	DATA FOR THE ENROLMENT:                                                                  To be filled in ONLY after arrival
Date of beginning of the study period at the University of Florence:  ............................................................

SOCRATES coordinator of the programme or SOCRATES delegate	 
Signature: ………………………………    STAMP                             Date: …………………………………….: 

ORIGINALE

 	Name of student: ............................................................	Registration N°: ......................................
Nome e cognome dello studente	N° di matricola
Home institution:..............................................................................	Country : .....................................
Istituzione di  origine	Paese
Main reasons why I wish to study abroad:
Principali motivi dello studio all’estero
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
 If necessary, continue on a separate sheet
	
	CURRENT AND PREVIOUS STUDY
STUDI  ATTUALI  E  PRECEDENTI 
Iscritto(a) al Corso di laurea/diploma in 
Diploma/degree for which I am currently studying: ......................................................................................
Durata legale del corso
Duration of course: .........  years              Years of study prior to departure abroad : .....................................
	
I have already been studying abroad.                                                     Yes         No  
Precedenti soggiorni di studio all’estero
If Yes, when? ...........................	
Se si, quando?
At which institution?......................................................................................
Presso quale istituzione?

I have benefited of Socrates/Erasmus status before:                                    Yes         No  
Ho beneficiato dello status di studente Socrates/Erasmus in precedenza:
	
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A	WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
ESPERIENZE DI  LAVORO (se rilevanti ai fini degli studi intrapresi)

Type of work experience               Company / organization                    dates                           country
Tipo di lavoro svolto                               Ditta / Ente                                           periodo                           paese

………………………………..         ……………………………………..     …………     ………………………
………………………………..         ……………………………………..     …………     ………………………
………………………………..         ……………………………………..     …………     ………………………

LANGUAGE COMPETENCE
              CONOSCENZA LINGUISTICA
D
I	            Livello di conoscenza
                       proficiency
Languages
Lingue straniere	
Mother tongue
Lingua madre	
Excellent
Ottima	
Good
Buona	
Fair
Media	
F	        Italiano	            	             	             	             	
I	        English	            	             	             	             	
R	        Français	            	             	             	             	
E	        Deutsch	            	             	             	             	
N	        Español	            	             	             	             	
Z	Other: .........................	            	             	             	             	
E	Other: .........................	            	             	             	             	

         Language of instruction at home institution (only if different from mother tongue) …………………………….
        Lingua di insegnamento nell’università di origine (solo se diversa dalla lingua madre)

SOCRATES  /  ERASMUS
ECTS - EUROPEAN CREDIT TRANSFER SYSTEM (if adopted)
LEARNING AGREEMENT
ACCORDO DIDATTICO
       ACADEMIC YEAR       ..../....	FIELD OF STUDY: .................................................................
         ANNO ACCADEMICO	AREA DISCIPLINARE
ORIGINALE	Name of student: ............................................................	Registration N°: ......................................
Nome e cognome dello studente	N° di matricola
Home institution:..............................................................................	Country : .....................................
Istituzione di origine	Paese
Host institution:     FIRENZE 01                                                               Country: ITALY
Istituzione ospitante                                                                                                              Paese
Faculty: ……………………………………………………………………
Facoltà	
                                                                                    STUDY PROGRAMME
                                                                                       PROGRAMMA DI STUDIO
PER	
ECTS Code, if any	
Course Unit
Insegnamento	Y / S 
Annual, semestral,	ECTS Credits
crediti ECTS	
 
LA	
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SEG	
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A	                                                                                                                           Total expected credits	 ……………	
	If necessary, continue on a separate sheet
Se necessario, continuare su un foglio separato
Student’s signature : .........................................................................
Firma dello studente	
	HOME INSTITUTION                                                 	ACCORDO DIDATTICO
ISTITUZIONE DI ORIGINE	LEARNING AGREEMENT
We confirm that this proposed programme of study is approved.
Per approvazione del programma di studio proposto
Socrates Institutional/Departmental coordinator	Responsible academic tutor
Coordinatore SOCRATES	Responsabile accademico
Name (nome): .............................................................	Name (nome): ..............................................................
Signature  (firma): .......................................................  Signature  (firma): .......................................................	
	HOST INSTITUTION (FIRENZE 01)	LEARNING AGREEMENT
ISTITUZIONE OSPITANTE	ACCORDO DIDATTICO
We confirm that this proposed programme of study is approved.                     
Per approvazione del programma di studio proposto                                             FIRENZE, ...................................................
Socrates coordinator of the programme or
Socrates delegate:                                     .......................................     ..................................................
                                                                                          Name (nome)                                   Signature  (firma)	

SOCRATES  /  ERASMUS                                          ACADEMIC YEAR   ....../......
       LEARNING AGREEMENT (2)
      ACCORDO DIDATTICO (2)

ORIGINALE	Name of student: ............................................................	Registration N°: ......................................
Nome e cognome dello studente	N° di matricola
Home institution:..............................................................................	Country : .....................................
Istituzione di origine	Paese
Host institution:     FIRENZE 01                                                               Country: ITALY
Istituzione ospitante                                                                                                              Paese
Faculty: ……………………………………………………………………
Facoltà
	
                                                CHANGES TO ORIGINAL STUDY PROGRAMME
CAMBIAMENTI DEL PROGRAMMA DI STUDIO ORIGINARIO

(to be filled in ONLY if appropriate)                                                                 (compilare SOLO se del caso)
	
ECTS Code, if any	
Course Unit
Insegnamento	  deleted              added
course unit
insegnamenti
  cancellati              aggiunti	ECTS
Credits

crediti ECTS	
P
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		If necessary, continue on a separate sheet.
	Se necessario, continuare su un foglio separato.
           Firma dello studente
         Student’s signature : ...................................................................................

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A	HOME INSTITUTION                                                 	LEARNING AGREEMENT
ISTITUZIONE DI ORIGINE	ACCORDO DIDATTICO
We confirm that this proposed programme of study is approved.
Per approvazione del programma di studio proposto
Socrates Institutional/Departmental coordinator	Responsible academic tutor
Coordinatore SOCRATES	Responsabile accademico
Name (nome): .............................................................	Name (nome): ..............................................................
Signature  (firma): .......................................................  Signature  (firma): .....................................................
FIRENZE, ...................................................	
	HOST INSTITUTION                                                 	ACCORDO DIDATTICO
ISTITUZIONE OSPITANTE	LEARNING AGREEMENT
We confirm that this proposed programme of study is approved.                     
Per approvazione del programma di studio proposto                                             FIRENZE,............................................
Socrates coordinator of the programme or …………………………..         ……………………………
Socrates delegate                                                    Name (nome)                                   Signature  (firma)