no - MEiL - Politechnika Warszawska

KEY ACTION 1 – MOBILITY OF INDIVIDUALS
HIGHER EDUCATION STUDENTS
ERASMUS + Poniższy wzór zawiera wypełnione 3 Application
STUDENT APPLICATION FORM
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
Lotnictwo i Kosmonautyka
Power Engineering
Nuclear Power
Engineering
Automatic Control
and Robotics
Automatyka i
Robotyka
Mechanika i Budowa
Maszyn
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; [email protected]
dr inż. Nikołaj Uzunow (power & nuclear); Faculty Erasmus Coordinator; + 48 22 234 52 97 ;
[email protected]
Dean - name, telephone and telefax numbers, e-mail box Prof. Janusz Frączek; [email protected]
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
YES/ NO
Previous participation in Erasmus at the same level of study
Study Cycle: FIRST
SECOND
THIRD
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
1. Univeristy of Genova
2.
................................
3. .
.................................
... Italy .........
....
......
......
.....
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 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
I am currently studying
this language
yes
I have sufficient
knowledge to follow
lectures
no
yes
I would have sufficient knowledge to
follow lectures if I had some extra
preparation
no
yes
no
..... English ......
.... Italian .....
..... French........
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
provisionally accepted at our institution
not accepted at our institution
Tutor’s signature
Dean’s signature
..............................................................................
Date: ....................................................................
..........................................................................................
Date :................................................................................
KEY ACTION 1 – MOBILITY OF INDIVIDUALS
HIGHER EDUCATION STUDENTS
ERASMUS +
Wypełnij w przypadku wybrania
dodatkowej uczelni przyjmującej
poza wcześniej wpisaną (docelowo
można wybrać do 3 uczelni)
tzw. uczelnia drugiego wyboru
STUDENT APPLICATION FORM
(Photograph)
ACADEMIC YEAR 2017/2018
FIELD OF STUDY:
Aerospace Engineering
Lotnictwo i Kosmonautyka
Power Engineering
Nuclear Power
Engineering
Automatic Control
and Robotics
Automatyka i
Robotyka
Mechanika i Budowa
Maszyn
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; [email protected]
dr inż. Nikołaj Uzunow (power & nuclear); Faculty Erasmus Coordinator; + 48 22 234 52 97 ;
[email protected]
Dean - name, telephone and telefax numbers, e-mail box Prof. Janusz Frączek; [email protected]
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
YES/ NO
Previous participation in Erasmus at the same level of study
Study Cycle: FIRST
SECOND
THIRD
Proszę wpisać uczelnię
drugiego 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
1. Ecole Centrale de Nanates
2.
France/Francja
.........
................................
3. .
.................................
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
I am currently studying
this language
yes
I have sufficient
knowledge to follow
lectures
no
yes
I would have sufficient knowledge to
follow lectures if I had some extra
preparation
no
yes
no
..... English ......
.... Italian .....
..... French ........
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
provisionally accepted at our institution
not accepted at our institution
Tutor’s signature
Dean’s signature
..............................................................................
Date: ....................................................................
..........................................................................................
Date :................................................................................
KEY ACTION 1 – MOBILITY OF INDIVIDUALS
HIGHER EDUCATION STUDENTS
ERASMUS +
Wypełnij w przypadku wybrania
dodatkowej uczelni przyjmującej
poza wcześniej wpisaną (docelowo
można wybrać do 3 uczelni) tzw.
uczelnia trzeciego wyboru
STUDENT APPLICATION FORM
(Photograph)
ACADEMIC YEAR 2017/2018
FIELD OF STUDY:
Aerospace Engineering
Lotnictwo i Kosmonautyka
Power Engineering
Nuclear Power
Engineering
Automatic Control
and Robotics
Automatyka i
Robotyka
Mechanika i Budowa
Maszyn
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; [email protected]
dr inż. Nikołaj Uzunow (power & nuclear); Faculty Erasmus Coordinator; + 48 22 234 52 97 ;
[email protected]
Dean - name, telephone and telefax numbers, e-mail box Prof. Janusz Frączek; [email protected]
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
YES/ NO
Previous participation in Erasmus at the same level of study
Study Cycle: FIRST
SECOND
THIRD
Proszę wpisać uczelnię
trzeciego 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
1. RWTH Aachen
2.
................................
3. .
.................................
Niemcy
.........
....
......
......
.....
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 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
I am currently studying
this language
yes
I have sufficient
knowledge to follow
lectures
no
yes
I would have sufficient knowledge to
follow lectures if I had some extra
preparation
no
yes
no
..... English ......
.... Italian .....
..... French ........
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
provisionally accepted at our institution
not accepted at our institution
Tutor’s signature
Dean’s signature
..............................................................................
Date: ....................................................................
..........................................................................................
Date :................................................................................