KHAZAR UNIVERSITY

ERASMUS+ PROGRAMME
INTERNATIONAL CREDIT
MOBILTY-ICM

INTERNATIONAL CREDIT MOBILTY-ICM

APPLICATION FORM FOR STUDENTS MOBILITY FOR STUDIES
Name- Surname:Ali Mehdiyev Gender: M  F 

Date- Place of birth: Nationality:

dd/mm/yyyy 05/12/2002 Azerbaijani
Home country: Home university:
Azerbaijan Khazar University PHOTO
Erasmus Code or city: Passport-National ID number:

Intended term of study: Field of study:

 Fall  Spring  Both
Level of study: Year of study:
 Bachelor 1 2
 Master  Doctorate 3 4
E-mail: Telephone:
ali.mehdiyev.010@gmail.com +994 552793001
Address:
M.A.Rasulzadeh, Khirdalan, Absheron
Contact person for emergency: Do you have any special needs (disability)?
Agabala Mehdiyev
Yes  (+10 pts) No 
Contact telephone/e-mail for emergency:
+994 557129850

Departmental coordinator at home university Institutional coordinator at home university

Name-Surname: Name-Surname:

E-mail: E-mail:

Signature/Date: Signature/Date/Stamp:

I certify that the information given in this application is true, complete, and accurate to the best of my knowledge.
Student’s name-surname: Ali Mehdiyev Date:

Student’s signature:

Please attach Europass CV, Copy of National Identity Card, Transcript and English Proficiency Document forms
Address: 11 Mehseti Street, Baku, AZ1096, Azerbaijan
Phone : +994 12 421 79 16 (extension 240), +994 12 421 17 08 (direct)
E-mail : erasmus@khazar.org
Web sitesi: http://international.khazar.org/
Please attach the “Disability” status documents if necessary.

Address: 11 Mehseti Street, Baku, AZ1096, Azerbaijan

Phone : +994 12 421 79 16 (extension 240), +994 12 421 17 08 (direct)
E-mail : erasmus@khazar.org
Web sitesi: http://international.khazar.org/