01/08/2016 ICM NOVA 2016-2018 | Erasmus + Key Action 1 International Credit Mobility

Proposed Study Plan

ACADEMIC YEAR _____/_____
1.MOBILITY INFORMATION

Personal Information
Surname (Family name) Given name (First name)

Date of birth e−mail address

Home institution
Home institution

Current field of study Current level of study

Undergraduate □ 1 □ 2 □ 3 □ 4
Master □ 1 □ 2
PhD □ 2 □ 3
Full Name of student advisor e−mail of student advisor

Department of student advisor Position of student advisor

Host institution
Host institution

Full Name of student advisor e−mail of student advisor

Department of student advisor Position of student advisor

Field of study Level of study

Undergraduate □ 2 □ 3 □ 4
Master □ 1 □ 2
PhD □ 2 □ 3
Length of the mobility (months)
□ 5 months

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01/08/2016 ICM NOVA 2016-2018 | Erasmus + Key Action 1 International Credit Mobility

2. Details oƒ the proposed study programme abroad (check the respective syllabus of the host
institution)

Details of the programme studies: courses selected by the student and validated by the
home institution which will be followed at the host institution (minimum 25 ECTS credits):
Course Course Title Course year Number of
Code Specialization ECTS credits

Total

The Student The Local Coordinator/contact at

Home HEI
We confirm that the proposed
programme of study/Learning
Agreement is approved and that the
credits earned at the hosting HEI
within such programme will be
recognized.

(Name) (Name)

(Date) (Date)

(Signature) (Signature and stamp)

* Host institution will sign when the applicant is definitely selected

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