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ERASMUS+ Programme

STUDENT APPLICATION FORM

ACADEMIC YEAR

2016 / 2017

This application should be completed in BLACK in order to be easily copied and/or telefaxed.

SENDING INSTITUTION

UNIVERSITATEA DE ARTE GEORGE ENESCU DIN IAI


Cuza-Vod no. 29, 700040 Iai, Romnia
Tel: +40232276020; Fax: +4023276020; email: erasmus@arteiasi.ro
www.arteiasi.ro

Erasmus Code : RO IASI01


Institutional coordinator (name, signature)
PhD. Prof. Florin Grigora

Seal of institution

RECEIVING INSTITUTION: JOSEPH HAYDN KONSERVATORIUM DES LANDES BURGELAND , EISENSTADT


Glorietteallee 2 , A-7000 Eisenstadt , Austria
Tel: +43(0)2682/ 63734; Fax: +43(0) 2684/ 63734-4;
Email: post.haydn.kons@bgld.gv.at
Institutional coordinator (name, signature)

Seal of institution

STUDENTS PERSONAL DATA


(to be completed by the student applying)
First name(s): Ana Larisa
Family name: Iordache
Date of birth: .15.01.1994
Place of Birth: Targu-Neamt , Romania
Sex: Female
Current address: Str. Bucium 17 , Bularga,
Camin C1 , room 05 , Iasi , Romania
e-mail : larisuculicucica@yahoo.com
Tel.: +40754398890

Identity document
Permanent address (if different):Str.Crangului, nr . 10 ,
Targu-Neamt, Neamt, Romania
Tel.: +40754398890
Nationality: Romanian
Student's signature,

Date ..

Desired direction of study / Proposed project .

Erasmus +

Briefly state the reasons why you wish to study abroad?

I would honour the opportunity if you accept me for the Erasmus programme, because it will mean a lot for
me and for my future career prospective. Firstly, it would definitely be a very efficient and successfully
method to improve my English skills. I have been learning English as my first foreign language and I
believe that this experience at your University will improve a lot my knowledge because I will get a chance
to communicate with students in similar circumstances. I advocate the opinion that Erasmus programme is
excellent opportunity to meet various groups of people, spend quality time with them and get to know their
habits, attitudes, lifestyle etc. Also, living and studying within international students would broaden horizons
and enable me to build strong social network with people through our continent.

LANGUAGE COMPETENCE
Mother tongue: Romanian......Language of instruction at home institution (if different): ..................
Other languages

I am currently studying
this language

I have sufficient
knowledge to follow
lectures

I would have sufficient knowledge to


follow lectures if I had some extra
preparation

yes

no

yes

no

yes

no

English

Period of study
Arrival :01/09/2016

Accommodation:

Departure : 15/ 02/2017

Desired price range ( 500 Euro/person/month)

Transport: by plane

PREVIOUS AND CURRENT STUDY


Diploma/degree for which you are currently studying: ..............
Speciality (if any) : viola
Current study year (at the moment of departure abroad); 4
Have you already been studying abroad?
Yes
No
If Yes, when? at which institution ? ............ ............................

RECEIVING INSTITUTION
We hereby acknowledge receipt of the application.
The above-mentioned student is

accepted at our institution


not accepted at our institution

Dean,
..............................................................................
Date: ....................................................................

Institutional coordinator
..........................................................................................
Date :................................................................................