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Mobility Report: STUDENT REPORT

Academic Year: _________________


Please indicate:
CEEPUS Network Number
(CPnr.):___________________________
Or Freemover
Dear CEEPUS Student!
Your feedback is very important for CEEPUS, so please forward tis report to your National
CEEPUS Office (NCO! within two weeks after returning from your ost country or as
advised by your "ational CEEPUS #ffice! $ %ank you!
Contact Addresses: National CEEPUS Oices
WWW.CEEPUS.INFO
1. Basic Personal Data:
1.1 Personal Data
academic degree:
first name:
last name:
sex: male female
date of birth:
citizenship:
1.2 Country of origin: please tick appropriate box:
= country of your home institution
Austria Poland
Bulgaria Slovakia
Croatia Slovenia
Hungary
1.3 Host country : please tick appropriate box:
multiple entries if necessary
Austria Poland
Bulgaria Slovakia
Croatia Slovenia
Hungary
1
1.4 Period of Stay
as in your Letter of Confirmation
from: dd!mm!yy" ######to: dd!mm!yy":######in: host country":##############
from: dd!mm!yy" ######to: dd!mm!yy":######in: host country":##############
from: dd!mm!yy" ######to: dd!mm!yy":######in: host country":##############
1.4.1 Prolongation: Was your CEEPUS grant prolonged
please tick appropriate box
yes no
1.4.2 Duration: !otal in sc"olars"ip #ont"s (incl. prolongation where applicable)
please tick appropriate box
$ % & ' ( ) * + , $- $$ $%
1.$ %ield of Study &'nde( copyrig"t S)') Slo*ens+a,-
please mark the appropriate box according to your general field of study
o
$'---- ./0CA1234 5 1.ACH.6 16A24247
o
$+---- 824. 5 APP92./ A61S
o
%%---- H0:A4212.S
o
%)---- 6.927234 5 1H.3937;< 7.4.6A9
o
&----- S3C2A9 5 B.HA=2306A9 SC2.4C.S
o
&'---- B0S24.SS A/:242S16A1234 5 :A4A7.:.41
o
&+---- 9A>
o
'%---- 4A106A9 SC2.4C.S
o
')---- :A1H.:A12CS 5 C3:P01.6 SC2.4C.
o
(----- :./2CA9 SC2.4C.S
o
(%---- 1.CH43937;
o
('---- .4724..6247
o
(+---- A6CH21.C106. 5 13>4 P9A44247
o
)%---- A762C09106.< 836.S16; 5 82SH.6;
o
))---- H3:. .C343:2CS /3:.S12C SC2.4C."
o
*----- 16A4SP361 5 C3::042CA1234S
o
*+---- S.6=2C. 16A/.S
o
+'---- :ASS C3::042CA1234 5 24836:? SC2.4C.S
o
+,---- S.C0621; 5 6.C6.A1234
1.. /ocal Deno#ination of your %ield of Study &in Englis",
2
1.0 Student Progress
>hen consuming my C..P0S grant< 2 @as in my 11111111111111semester?
2. Studying Abroad
2.1 Host 'nstitution:
university:
faculty!institute:
country:
2"ere applica3le also second "ost institution:
university:
faculty!institute:
country:
2.2 )cti*ities: /ectures and Courses
Please list the lecturescourses attended:
Note: !ou may add another sheet of paper
1itle 1ype of
2nstruction
9anguage of
2nstruction
hrs per
@eek
exam
passed:
yes!no
2.3 )cti*ities: 4t"er types of instruction
3
please tick appropriate box" multiple entries are possible
2 have participated in!attended:
9aboratory @ork
Practical training
>orked on my thesis
Summer School
other activities:please specify:
#################################################
2.4 'ntegration:
please tick appropriate box
%?'?$ /id you feel @ell integrated during your stay in the host country:
academically yes no
i?e? assistance in finding your @ay at the host institution< tutoring or similar activitiesA"
socially yes no
e?g? buddy net@ork"A
%?'?% >ere there any special activities to encourage integrationA
yes no
if yes< please specify:
2.$ 4rgani5ational details: please tick appropriate box
%?(?$: Preparation:
/id you encounter any difficulties @hile preparing for your period of studying
abroadA
no yes
if yes< please specify: key@ords"
%?(?% Payment of Scholarship: Agency
By @hich agency!institution @as your scholarship paidA
4
%?(?& Payment of Scholarship: 2ntervals
At @hich intervals @as your scholarship paidA
monthly
@eekly
other interval:##########
%?(?' 3ptional 8unding:
/id you receive any additional C..P0S funding!fringe benefits by authorities or
institutions in your home country and!or your host countryA
yes no
if yes< please specify:
travel allo@ance
others< please specifiy:
%?(?(: 8ees
/uring your stay at your host institution< @ere you charged any feesA
no yes
multiple entries possible
if yes< please specify:
registration fees
tuition fees
laboratory fees
other fees:##############
%?(?) Accommodation: Preparation
0pon arrival at your host institution< ho@ did you arrange for accommodationA
multiple entries possible
accommodation @as arranged by host institution
checked local market @ith assistance of:###############
checked local market alone
other arrangement:################################
%?(?* Accommodation: 1ype
>hich type of accommodation did you use: multiple entries possible
student hostel hotel
youth hostel private room
private flat shared @ith other students guest house
private flat alone
5
other type of accommodation: ###############
3. After your return:
3.1 6ecognition please tick appropriate box
/id you have any difficulties in obtaining recognition of your period of studying
abroadA
no yes
if yes< please specify:
3.2 7no2ledge of /anguages please tick appropriate box
>as there any improvement in your language skillsA
yes no

if yes< grade your skills B after your return B on the table belo@:
- C not at all< 2 C basic< 22C intermediate< 222Cfluent"
!
1
" "" """ ! " "" """ ! " "" """
Englis" 8ulgarian Polis"
9er#an Croatian Slo*enian
%renc" C5ec" Slo*a+
Hungarian
3.3 Possi3le Difficulties please tick appropriate box
/id you encounter any difficultiesA
no yes
2f yes< @hat @ere your biggest difficultiesA
1
! not at a""# $! ba%ic# $$! intermediate# $$$!&"uent. P"ea%e note: $& 'ou do not mark an' bo(# )) no
com*etence wi"" be a%%umed: P"ea%e indicate a"" bo(e%+
,
3.4 Possi3le i#pro*e#ents
2f you have suggestions for improvement< please let us kno@:
3.$ :et2or+ Perfor#ance
2f you could rate the performance of your net@ork< @hich grades @ould you give for
overall performance:
excellent
ok
room for improvement
Ho@ did you arrive at this conclusion< @hich criteria did you applyA
3.. )ssistance for future CEEPUS students please tick appropriate box
>ould you be interested in sharing your C..P0S kno@Bho@ @ith future studentsA
yes no
3.0 8est #e#ory
>hat is the best memory of your C..P0S experienceA
# agree to electronic processing of the data pro$ided
Signature: 1111111111111111111111111111111 Date:11111111111111111111
1HA4D ;30 836 ;306 C33P.6A1234EEE
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