Erasmus+ ICM Before the Mobility Form for Incoming Student Participants

DATA DECLARATION FOR PREPARING THE GRANT AGREEMENT

Given name (as in passport)

Family name (as in passport)

Place of birth (town, country)

Date of birth (DD/MM/YYYY)

Nationality (as in passport)

Official address in full (zip code, country, town, street name, street number)

Address for notification (zip code, country, town, street name, street number)

Phone number (with country code)

E-mail address (that you always use)

Gender

Passport number

Academic year (when the mobility takes place)

Number of completed higher education study years (by the time you start the mobility)

Study cycle (during the mobility)

Your faculty/department

Your field of studies

Mobility Data

What type of Erasmus+ mobility will you partake in?

Have you already participated in an Erasmus+ mobility at your current level of studies?

If yes, how long did your mobility take (how many months)?

OLS

Have you taken the OLS test?

Yes.

No.

If your answer is "no", please indicate the reason here.

If you have chosen "Other", please explain it here.

If you have successfully taken the OLS test, please attach a screenshot of the result (clearly showing the language, your name and the test result) to this form at the bottom. If you do not know what an OLS test means, please read the website on Before the Mobility.

DATES OF THE MOBILITY PERIOD

Start date of your mobility (DD/MM/YYYY)

The start date of your mobility period shall be the first day you need to be present at ELTE, or the host organization/enterprise. In case you do not yet know the exact date of your travel, enter the start and end dates of the semester you will be present at your host university (and then try to arrive and leave at that time). Check the actual academic calendar of ELTE here or inquire at your ELTE faculty coordinator.

End date of your mobility (DD/MM/YYYY)

The end date of the period abroad shall be the last day you need to be present at ELTE or another receiving organisation. This is normally the last day of semester. Please bear in mind that if you leave earlier than this date it might result in financial consequences. For further information check out our website for incoming students.

FINANCIAL DETAILS

You will participate in a mobility with

financial support from Erasmus+ EU funds

zero grant (free waiver, without Erasmus+ support)

Erasmus+ top-up for students with fewer opportunities

Please inquire at your home institution if this kind of Erasmus+ top-up grant might be available.

Have you applied for / are you going to apply for Erasmus+ additional support for students with fewer opportunities at your sending institution?

Yes.

No.

If yes, please indicate here on what reason you might be eligible for the top-up grant.

Erasmus+ top-up for green travel

Do you apply for a green travel top-up? (Available only for students from Bosnia and Herzegovina and Ukraine. If you are coming from a different country, select "No".)

Yes.

No.

If yes, what means of transport do you opt for?

If you have chosen the last option, please specify it here.

Please bear in mind that if you apply for a green travel top-up, you will have to provide evidence of travelling green. Remember to keep your train/bus tickets, payment receipts or any kind of other proof (receipts from the gas station, road tolls etc.).

Bank Details

Bank account where the financial support should be paid

Bank account holder's name

Bank name

Clearing/BIC/SWIFT code (Bank identification code)

Account number with IBAN-code

Currency of the Bank Account*

*When choosing from the above options, please take into account that ELTE will pay your grant support in euros. In order to avoid paying unnecessary fees, you may wish to consider opening a euro bank account or find any other favorable option for receiving your grant support.

If you have chosen "Other", please specify

Correspondent Bank

If your local bank receives international money transfers via a correspondent bank, please provide its data here. (In case you do not have an IBAN number, it is probable that your bank can receive money transfers from the EU only via a correspondent bank. Please contact your bank for details.)

Correspondent bank name

Correspondent bank SWIFT code

Correspondent bank account number

INSURANCE

It is mandatory to be insured for the entire period of the mobility. You must take out a health insurance. Nevertheless, taking out an accident insurance and a liability insurance is only recommended to students on traineeship depending on the type of work they intend to do. If you do not wish to take out any insurance other than health insurance, you can enter the details of your health insurance for the two other insurances, but this does not mean that you have the accident and liability insurances.

Health Insurance

If you are an incoming student, please bear in mind that your health insurance should be accepted in the European Union. This means that it should cover at least 30 000 EUR possible expenes for the entire mobility period and it should be valid within the Schengen Area.

Name of the health insurance company

Policy number of your health insurance (unique number identifying your health insurance account)

Accident Insurance

Name of the insurance company

Policy number of accident insurance

Liability Insurance

Name of the insurance company

Policy number of liability insurance

ATTACHEMENTS

Learning Agreement (signed by all parties)

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OLS test result

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Scanned copy of passport

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Scanned copy of health insurance policy or insurance card

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Certificate of Student Status*

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*The certificate should confirm that you are a student of your home university and will be enrolled there during the entire mobility period. This document shall certify that you are an active, registered student at your home university during the entire mobility period.

DECLARATION OF PROMOTIONAL ACTIVITY

The aim of the promotional activity is to promote the Erasmus+ ICM program by sharing your experiences gained during the mobility period on ELTE’s website. Students undertaking promotional activities can choose the form of them. The submitted promotional materials may be published. In case of an in-person presentation, students may be asked to present their experiences at Erasmus+ ICM events, information days etc. Promotional activities are not obligatory.

If you would like to share your scholarship experiences and thus contribute to the promotion of the Erasmus+ ICM program at ELTE, please indicate the preferred form of it (you can indicate more):

Presentation at Erasmus+ ICM promotion events, information days etc.

Photo report (at least 10 photos of the mobility period with a personal introduction and description of 2-3 sentences per picture)