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Anex 1

ERASMUS + International Credit Mobility

Declaration of Interest

I, the undersigned:

Name:_________________________________________________________

Surname:_______________________________________________________

Date and place of birth:_____________________________________________________

Citizenship:______________________________________________________

Address:________________________________________________________

(Cell) phone number:_______________________________________________________

Email address:________________________________________________________

University:______________________________________________________

Degree Programme:_____________________________________________________

Year:__________________________________________________________

Subject Area:__________________________________________________________

declare that I wish to participate in the .Erasmus + mobility at the University of Pisa for the

o Spring semester 2015-16 or

o Fall semester 2016-17

My motivations for applying are the following:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

My linguistic competences are as follows:

Language Level

written

Level

speaking

Level

understanding

Certification

(if any)

I understand that if my pre-candidature is selected, I will be asked to prepare a Full Application, including a complete Learning Agreement, which I must submit by 25th of December 2015 to the Erasmus Coordinator of my University.

I annex a copy of my exam booklet and/or Transcript of records

Signature:_______________________________________

Date:___________________________________________