ERASMUS+ STUDENT MOBILITY
ENROLMENT FORM
ACADEMIC YEAR   2024 / 2025
ANNO ACCADEMICO

FIELD OF STUDY (ISCED code) (e.g. 0230, 0111, 0222, etc.):  .......................................
CODICE ISCED

(photo)

This application should be completed in BLACK and in CAPITAL LETTERS
Si prega di compilare questa domanda in NERO e in STAMPATELLO

HOME INSTITUTION                                                                     ERASMUS CODE: ..................................
Name and full address: ..................................................................................................................................
                                              ..................................................................................................................................
Institutional/Departmental coordinator of the programme:  
…………………………………………………………………………………………………………….
telephone: .....................................................   e-mail: ...................................................................................

COORDINATOR’S SIGNATURE                  STAMP OF THE HOME INSTITUTION or Erasmus Office                  
 ……………………………………...                 …………………………………………………………………….
                                                                                                     (APPLICATION NOT ACCEPTED IF MISSING)

STUDENT’S PERSONAL DATA 	
Family name: ............................................	First name(s): ............................................ Gender:  F;  M
Cognome	Nome	Genere
Date of birth: ........................   Place of birth: ...................................... Nationality: .......................................
Data di nascita                                     Luogo di nascita                                                Cittadinanza

Tel.: ...........................................................................  e-mail: ........................................................................
Emergency Contacts (please specify name, relationship, contact number/e-mail) ……………………………………….
…………………………………………………………………………………………………………………………

CURRENT STUDIES
Enrolled in (at the home Institution)  1^st cycle (bachelor)   2^nd cycle (master)  3^rd cycle (PhD)
(Please specify the degree course) …………………………………………………………………………………………
Iscritto/a al Corso di laurea/laurea magistrale/Dottorato

Host Institution
Istituzione ospitante
UNIVERSITÀ di FIRENZE
I FIRENZE01

School:  Humanities and Education

Period of study
periodo
   from (da)          to (a)  

................           ................

Duration of stay (months)
Durata del 
soggiorno (mesi)

............................

expected ECTS credits
crediti ECTS previsti

.........................

LANGUAGE COMPETENCES CONOSCENZE LINGUISTICHE

Language
Proficiency Lingue straniere

Mother tongue
Madrelingua

C2

C1

B2

B1

A2

A1

| Italiano | | | | | | |
| English | | | | | | |
| Français | | | | | | |
| Deutsch | | | | | | |
| Español | | | | | | |
| Other: ......................... | | | | | | |
| 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)

   Personal Information and Privacy Protection
Pursuant to Article 13 of the Regulation (EU) 2016/679 GDPR - General Data Protection Regulation - and to the Italian Legislation no. 196 dated 30/06/2003, I hereby authorize the University of Florence to use and process my personal data for the relevant Erasmus mobility procedures in compliance with the current legislation and with its institutional aims.

YES   NO 

Date _______________________				Student’s Signature__________________________

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
Erasmus Coordinator	
Il delegato Erasmus prof. Donatella Pallotti / Rossella Certini / Monica Ballerini	

Signature: ………………………………………    Date: …………………………  STAMP