Application

Online-Application for studying abroad

Bewerbungsformular Exchange

Identity

Surname*

First name*

gender*

male

female

undefined

date of birth*

Place of birth*

Nationality*

student ID (Matrikel)*

Contact

Street*

Street 2

postal code / ZIP*

City*

Country*

Phone number

E-mail at university

E-mail, which you use regularly*

Statements about your study

Department*

Current Course*

Current course semester*

Current level*

Bachelor

Master

Exchange request (up to 2 possibilities)

Request 1:

Starting semester*

Duration in semesters*

Country*

University*

Request 2 (optional):

Starting semester

Duration in semesters

Country

University

scholarship

Have you already received a scholarship for a stay abroad in the past?*

yes

If 'yes' - which one? - please choose*

Angaben zu bisheriger Förderung in vollen Monaten (0 = bisher kein Stipendium erhalten)*

Account owner*

Name of the bank*

IBAN*

BIC/SWIFT*

Emergency contact person

Surname*

First name*

Relationship*

E-mail*

Phone number*

Uploads (.pdf)

Current study certificate*

Current performance list*

… other documents

Declaration of agreement

Please confirm to accept our conditions for student exchange program.

Confirm conditions*

Yes

I agree that my name and e-mail address may be forwarded to students for the purpose of promoting the exchange program.*

Yes

Comments

Your comments

I have read the privacy policy.*

Contact person

Christian Lippold
Exchange & Erasmus+ Coordinator
03496 67 5115
christian.lippold(at)hs-anhalt.de