PAMUKKALE UNIVERSITY

ERASMUS+ STUDENT APPLICATION FORM

ACADEMIC YEAR 2019/ 2020 Photo
of
Student

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

The deadlines: 31st of July for winter and the full academic year
15th of December for the summer semester
FIELD of STUDY:
SEMESTERS : full  winter x summer 
x
SENDING INSTITUTION:

Name and Full Address:

ID CODE: MK TETOVO
University of Tetova
001
Blv, Ilinden, nn 1200 Tetovo, North Macedonia
ERASMUS+ Institutional Coordinator: Tel:+389 44 356 514
Prof. Arbër Çeliku Fax:
E-mail:arber.celiku@unite.edu.mk
Faculty: Department:
Applied Sciences Mechatronics
Faculty / Departmental Coordinator: Tel:
Prof. Dr. Asan Idrizi Fax:
E-mail: asan.idrizi@unite.edu.mk

STUDENT’S PERSONAL DATA:

Family Name: Ibraimi First Name(s): Berkan

Date of Birth: 26.Oct.1999 Sex: Male Nationality: Albanian
Place of Birth: Tetovo Marital Status: Single
E-Mail: berkanibraimi15@gmail.com
Current Address: Permanent Address (IF DIFFERENT):
Kiro Ristovski DRNC 73 Kiro Ristovski DRNC 73

Current Telephone: Permanent Telephone (IF DIFFERENT):

+389 70582863 +389 70582544

HOST INSTITUTION:
ECTS link: https://ebs.pau.edu.tr/BilgiGoster/DereceProgram.aspx?lng=2
http://ebs.pau.edu.tr/BilgiGoster/sayfa.aspx?lng=1&pi=42F0C0F9-F96D-4A94-A062-38FE8851C859

Name and Full Address:

PAMUKKALE UNIVERSITY Kınıklı Kampüsü Rektörlük Binası Kat:1 ID CODE: TR DENIZLI01
20160-Kınıklı-DENİZLİ-TURKEY
Erasmus+ Institutional Coordinator: Tel: +90-258-296 3352
Assoc. Prof. Dr. Zeha YAKAR Fax: +90-258-296 2343
E-mail: zyakar@pau edu.tr
Faculty: Department:

Pamukkale University - International Relations Office

Tel: +90 258 296 29 73 +90-258-296 23 56 Fax: +90 258 296 23 43
E-mail: internationaloffice@pau.edu.tr Web: http://pau.edu.tr/uluslararasi
Address: Kınıklı Kampüsü, Rektörlük Binası, 1. Kat TR-20160 DENIZLI / TURKEY
 Faculty / Departmental Coordinator: Tel:
Fax:
E-mail:

PREVIOUS and CURRENT STUDIES:

Diploma degree for which you are currently studying: Subject area code:

Duration: Years
First year of studies:
Expected date of conclusion:
Academic year you are currently studying in:
Have you studied abroad previously?

Yes No
If yes when at which institution?
Work Experience Related to Current Study (if relevant)
Type of work experience Firm/Organization: Date: Country:

………………… …………………… ……………… …………………

………………… …………………… ……………… …………………
………………… …………………… ……………… ………………...

LANGUAGE SKILLS:

Mother Language Language of instruction

at home institution(if different)

I am currently studying I have sufficient I need extra linguistic

Other Languages this language knowledge to preparation to follow lectures.
follow lectures.
Yes No Yes No Yes No

What qualifications do you have in Foreign Languages e.g. EFL, TOEFL, IELTS, TestDaF? (Where and when
obtained)

PERIOD of STUDY at PAMUKKALE UNIVERSITY:

Pamukkale University - International Relations Office

Tel: +90 258 296 29 73 +90-258-296 23 56 Fax: +90 258 296 23 43
E-mail: internationaloffice@pau.edu.tr Web: http://pau.edu.tr/uluslararasi
Address: Kınıklı Kampüsü, Rektörlük Binası, 1. Kat TR-20160 DENIZLI / TURKEY
Duration of Stay (in months) Expected Date of Arrival
Day/Month/Year: __ /__ / ____

Period of Study: from. …/.…/….. .to .…/.…/…...

ADDITIONAL DOCUMENTS TO BE PRESENTED upon ARRIVAL at THE HOST INSTITUTION:

 Copy of legal ID card or passport

 Copy of the registration at the home institution or university card
 Health insurance
 4 Passport type photographs
 Completed Learning Agreement (3 sets of originals)
 Up to date transcript
 Information about ID card

ACCOMMODATION:

Accommodation requests will only be considered when the form is submitted at least 2 months before the expected date of
arrival.

Do you need Accommodation? Yes No

Precise Date of Arrival: Date of Departure:

Fill in by Order of Preference

Hall of Residence
Flat
To be Completed Address:
by receiving
Institution Telephone:

Student’s Signature :and stamp International Office of the Sending Institution Responsible
Person’s Signature and Stamp:

Date:

Pamukkale University - International Relations Office

Tel: +90 258 296 29 73 +90-258-296 23 56 Fax: +90 258 296 23 43
E-mail: internationaloffice@pau.edu.tr Web: http://pau.edu.tr/uluslararasi
Address: Kınıklı Kampüsü, Rektörlük Binası, 1. Kat TR-20160 DENIZLI / TURKEY