Ek 10 T.R. SIFA UNIVERSITY The Office of International Affairs LIFELONG LEARNING PROGRAM / ERASMUS STUDENT APPLICATION FORM (Photograph) ACADEMIC YEAR 20.. / 20.. This application should be completed in BLACK in order to be easily copied, faxed or e-mailed STUDENT’S PERSONAL DATA Family name ID-Passport no. First name Applied for Nationality Date of birth (day/month/year) Home address Male Female Place of birth Street: City: Post Code: Country: E-mail Telephone: ACADEMIC DATA Name of home university, city and country Meliksah University Faculty or School Department Diploma/degree for which you are currently studying (bachelors/masters/doctorate) Present year of studies (i.e. 1st, 2nd…) Have you previously studied abroad? Yes No If Yes, when and at which institution? Study period at Host University 1st Semester (September-February) 2nd Semester (February-June) Languages known English Other: ........................... Adres: Şifa Üniversitesi, Uluslararası İlişkiler Ofisi, Ankara Cad. No:45,35100, Bayraklı/ Izmir/Türkiye Address: Sifa University, International Office, Ankara Cad. No.45, 35100, Bayrakli/IZMIR/ TURKEY Email: erasmus@sifa.edu.tr Web: http://international.sifa.edu.tr Tel: +90 (232) 308 00 00 Fax: +90 (232) 308 0 308 Ek 10 T.R. SIFA UNIVERSITY The Office of International Affairs Briefly state the reasons why you would like to study at abroad? LLP / ERASMUS DATA Faculty/School at Host University Department Erasmus Code of Home University. TR IZMIR09 Erasmus Department Coordinator at Home University (contact info) Erasmus Institutional Coordinator at Home University Date Prof.Dr. Halil İbrahim Atabay Sifa University International Relations Office Tel: +90 232 308 00 00 Student’s signature Fax: +90 232 308 0 308 E-mail: halil.atabay@sifa.edu.tr Institutional Coordinator Signature and Stamp RECEIVING INSTITUTION We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate’s Transcript of records. The above-mentioned student is: provisionally accepted at our institution not accepted at our institution Departmental coordinator’s signature: Institutional coordinator’s signature: Date: Date: Adres: Şifa Üniversitesi, Uluslararası İlişkiler Ofisi, Ankara Cad. No:45,35100, Bayraklı/ Izmir/Türkiye Address: Sifa University, International Office, Ankara Cad. No.45, 35100, Bayrakli/IZMIR/ TURKEY Email: erasmus@sifa.edu.tr Web: http://international.sifa.edu.tr Tel: +90 (232) 308 00 00 Fax: +90 (232) 308 0 308
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