SERVIÇO DE ERASMUS E DE APOIO
À MOBILIDADE
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APPLICATION FORM
PORTUGUESE COURSE
ACADEMIC YEAR
/
PHOTO
I – MOBILITY DATA
FIELD OF STUDY
ST
 1 SEMESTER
ND
 2 SEMESTER
 FULL YEAR
MOBILITY PERIOD
 STUDIES (SMS)
 PLACEMENT (SMP)
 INTENSIVE PROGRAMME (IP)
TYPE OF MOBILITY
DEPARTURE DATE
ARRIVAL DATE
SENDING INSTITUTION
COUNTRY
 ISCS-N (GANDRA)
CESPU SCHOOL
 ESS-VS (GANDRA)
 ESS-VA (V.N.FAMALICÃO)
II– PERSONAL DATA
FIRST NAME(S)
LAST NAME(S)
NATIONALITY
GENDER
DATE OF BIRTH
 FEMALE
 MALE
PLACE OF BIRTH
 Sim
SPECIAL NEEDS
 Não
IF YES, INDICATE WHICH
ID / PASSPORT NUMBER *
PERMANENT ADRESS
POST-CODE /CITY
COUNTRY
EMAIL
PHONE NUMBER
PERSON TO CONTACT
PHONE NUMBER
IN CASE OF EMERGENCY
* Non-European students must add a VISA copy.
III - DATA FOR INVOICE
COMPLETE NAME
VAT NUMBER
ADRESS
POST-CODE / CITY
COUNTRY
TUITION FEE
IV– LANGUAGE COMPETENCE – SELF-EVALUATION
MOTHER
TONGUE
LANGUAGE OF INSTRUCTION AT HOME
INSTITUTION, IF DIFFERENT
OTHER
Basic User
LANGUAGES
A1
Beginner
Portuguese
Spanish
English
French
Other:





CEFR SCALE (READING, LISTENING, SPEAKING AND WRITING)
Independent User
Proficient User
A2
B1
B2
C1
C2
Elementary
Intermediate
Vantage
Advanced
Mastery

























V - STUDENT’S SIGNATURE
I certify that all the information provided in this application is correct and complete. I agree that these data will be stored and processed
electronically and transmitted to the universities concerned exclusively for the purpose of my ERASMUS application.
SIGNATURE
DATE
CESPU - COOPERATIVA DE ENSINO SUPERIOR POLITÉCNICO E UNIVERSITÁRIO, CRL.
IERAS.27/00
APPLICATION FORM
PORTUGUESE COURSE
SERVIÇO DE ERASMUS E DE APOIO
À MOBILIDADE
Página 2 de 2
DETAILS OF THE COURSE
PLACE
NUMBER OF
ECTS CREDITS
NUMBER OF HOURS
FROM
TO
*To be filled by CESPU Erasmus Office.
FINAL EVALUATION*
STUDENT’S NAME
EXAM
CLASSIFICATION
APRROVEMENT
(0-20)
 YES
 NO
(mimimum to pass – 10 out of 20)
TEACHER’S NAME
DATE
SIGNATURE
DATE
*To be filled by the teacher at the end of the course.
FILE MANAGEMENT*
APPLICATION FORM
 YES
 NO
PAYMENT
 YES
 NO
CLASSIFICATION
 YES
 NO
FINAL CERTIFICATE
 YES
 NO
*To be filled by CESPU Erasmus Office.
CESPU - COOPERATIVA DE ENSINO SUPERIOR POLITÉCNICO E UNIVERSITÁRIO, CRL.
IERAS.27/00