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 -