“STEFAN CEL MARE” UNIVERSITY OF SUCEAVA

MARE UN
IV
ERS
"ŞTEFAN CEL MARE” UNIVERSITY OF SUCEAVA
ITY
STEF AN C
E
L
1 , University Street, 5800 SUCEAVA, ROMANIA, http://www.usv.ro
tel: +40 30 520081; fax: +40 30 520080
SU CEAVA
ERASMUS STUDENTS – APPLICATION FORM
( for registration and accommodation )
2004 / 2005
1. SENDING INSTITUTION
Name and full address of the institution …………………………………………………………….
…………………………………………………………………………………………………………
Code of your institution (
): ………………………………………………
Departmental co-ordinator in your home institution:
Family name …………………………………….. First name ……………………………………..
Tel.…………………………… Fax. …………………………… E-mail. ………………………….
2. STUDENT’S PERSONAL DATA
Family name …………………………………….. First name ……………………………………..
Date of birth ……………………… Place of birth ……….………………………… Sex : M
F
Home country mailing address ……………………………………………………………………...
…………………………………………………………………………………………………………
Tel. ………………… Fax. (if available)……...………………… E-mail ………………………….
3. HOME STUDIES IN HIGHER EDUCATION
Field of study ………………………………………………………………………………………….
at the Faculty ………………………………………………………………………………………
4. STUDIES AT THE “STEFAN CEL MARE” UNIVERSITY OF SUCEAVA
Department of study …………………………………………………………………………………..
Faculty …………………………………………………………………………………………………
Name of the co-ordinator in the host university responsible with your visit ………………………….
…………………………………………………………………………………………………………
Period of study: From ………………………………. To ……………………………………………
5. ACCOMMODATION ( in the hall residence)
Period of stay: From ………………………………… To ……………………………………………
Date of arrival: ………………………………………………………………………………………
a) Fees for a room in the hall residence are 30 EUR / month.
b) Hall of residence is located close to the university and canteen, at 15 minutes walking. Rooms in
the hall residence have a surface of 10 m
2
, with a single bed, a washbasin, a table and a
wardrobe. Beds fully dressed, no need for sleeping beds. Sheets included. Shower rooms are in
the corridor ( one shower for 10 – 12 students).
c) Fees for meals ( breakfast, lunch and dinner) at university canteen are 5 EUR / day.
STUDENT’S SIGNATURE:
DATE:
CO-ORDINATOR IN YOUR HOME INSTITUTION:
Name:
Signature:
Note: Please, complete and return this application form not later than 1st August for the first
semester and 1st December for the second semester, to
University “Stefan cel Mare” Suceava
Associate prof. Sanda Maria ARDELEANU
Internationale Relations Department
University Street nr. 9, 720225 – Suceava, ROMANIA
Phone: 40 – 230 – 520081; 40 – 230 - 520316
Fax: 40 – 230 – 520080; 40 – 230 - 520316
email : [email protected]
MARE UN
IV
ERS
ITY
STEF AN C
E
L
UNIVERSITE “ŞTEFAN CEL MARE” SUCEAVA
SU CEAVA
ETUDIANTS ERASMUS – FORMULAIRE DE PRE-INSCRIPTION
( études et hébergement )
2004 / 2005
1. UNIVERSITE D’ORIGINE
Nom et adresse de l’université……… ……………………………………………………………….
…………………………………………………………………………………………………………
Code Socrates - Erasmus ( i.e. UK MANCESTER01): ………………………………………………
Personne de contact Socrates - Erasmus:
Nom ……………………………………….. Prénom(s)…….. ……………………………………..
Tel.…………………………… Fax. …………………………… Courriel. ………………………….
2. COORDONNEES PERSONNELLES DE L’ETUDIANT
Nom ……………………………………….. Prénom(s)…….. ……………………………………..
Date de naissance ……………Lieu de naissance ……….………………………… Sex : M
F
Adresse domicile ………………………………………………………………………...
…………………………………………………………………………………………………………
Tel. ………………… Fax. (if available)……...………………… Courriel ………………………….
3. ETUDES UNIVERSITAIRES DANS L’UNIVERSITE D’ORIGINE
Domaine ……………………………………………………………………………………………….
Faculte ………………………………………………………………………………………………...
4. ETUDES UNIVERSITAIRES DANS L’UNIVERSITE “STEFAN CEL MARE” DE
SUCEAVA
Domaine…………/ …………………………………………………………………………………..
Faculte ………………………………………………………………………………………………
Personne de contact Socrates / Erasmus dans l’Université de Suceava … …………………………..
…………………………………………………………………………………………………………
Durée du séjour : depuis……………………………. a... ……………………………………………
5. LOGEMENT ( dans le foyer étudiants)
Durée du séjour : depuis…………………………… à ……………………………………………
Date d’arrivée: ………………………………………………………………………………………
d) Le loyer d’une chambre est de 30 EUR / mois ;
e) Le foyer est situs tout près de l’université et de la cantine. Les chambres ont une surface de 10
m2 et sont dotées d’un lit, un lavabo, une table et une armoire. Les draps de lite sont prévus. La
salle de bain et les toilettes sont dans le couloir.
f) Le coût d’une pension complète ( petit déjeuner, déjeuner et dîner) est de 5EUR / jour .
SIGNATURE DE L’ETUDIANT,:
DATE:
COORDINATEUR SOCRATES / ERASMUS DANS L’UNIVERSITE D’ORIGINE ::
Nom:
Signature:
Note : Le présent formulaire, dûment rempli, doit être renvoyé jusqu’où 1er Juillet pour le
premiere semestre et 1 er Decembre , à
University “Stefan cel Mare” Suceava
Associate prof. Sanda Maria ARDELEANU
Internationale Relations Department
University Street nr. 9, 720225 – Suceava, ROMANIA
Phone: 40 – 230 – 520081; 40 – 230 - 520316
Fax: 40 – 230 – 520080; 40 – 230 - 520316
email : [email protected]