Annex 2 Erasmus+ for study a.y. 2022/2023
(THIS FORM MUST BE FILLED OUT DIGITALLY AND ATTACHED TO THE ON-LINE APPLICATION FORM)
	
I certify that all the information reported on this form is complete and correct.

I, the undersigned: Student ID __________ First name _____________________ Last name _____________________
declare that:
□ I have already received a previous grant for Erasmus Study and/or Placement and/or Traineeship and/or ICM offered by:
□ UNIMORE or
□ University of____________________________________________________________________    for a total of _____________ months during the a.y.  ________________________
□ I do not have received a previous grant for Erasmus Study and/or Placement and/or Traineeship and/or ICM
□ I have passed the following examinations but they have not yet been registered:

N°	Exam date	Exam/other activity	Mark	      Credits	
1		 	 	 	
2		 	 	 	
3		 	 	 	
4		 	 	 	
5		 	 	 	

□ I have achieved the First Level Degree in _____________________________________ at the University of ______________________________ obtaining the following final mark___________ __ and have passed the following examinations:
N°	Exam date	Exam/other activity	Mark	Semester/Credits	
1		 	 	 	
2		 	 	 	
3		 	 	 	
4		 	 	 	
5		 	 	 	
6		 	 	 	
7		 	 	 	
8		 	 	 	
9		 	 	 	
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11		 	 	 	
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20		 	 	 	

LANGUAGE SKILLS

IMPORTANT: students declaring not to have any language knowledge (or those declaring to have some language certificates below A2 level must attend a mandatory language course before the departure time).
Students declaring not to have passed a foreseen curricular foreign language exam or not to possess any language certificate must take a linguistic assessment test after the list of admitted students is published.

ENGLISH:
-	any:  □
-	examination (mark): _________ and/or passed NO □ – YES □ 
-	certificates: NO □ – YES □ (if yes, attaching the certificate is mandatory)
-	previous study experience(s) abroad: NO □ – YES □ (if yes, please specify where)
_______________________________________________________________________
-	previous assessment of language knowledge in order to enroll to the Master Degree: 
NO □ – YES □
-	other (please specify for ex. Mother tongue, lectorship etc.. ): __________________________ 	

FRENCH
-	any:  □
-	examination (mark): _________ (and/or passed) NO □ – YES □ 
-	certificates: NO □ – YES □ (if yes, attaching the certificate is mandatory)
-	previous study experience(s) abroad: NO □ – YES □ (if yes, please specify where)
_______________________________________________________________________
-	previous assessment of language knowledge in order to enroll to the Master Degree: 
NO □ – YES □
-	other (please specify for ex. Mother tongue, lectorship, etc.. ): __________________________ 

GERMAN
-	any:  □
-	examination (mark): _________ (and/or passed) NO □ – YES □ 
-	certificates: NO □ – YES □ (if yes, attaching the certificate is mandatory)
-	previous study experience(s) abroad: NO □ – YES □ (if yes, please specify where)
_______________________________________________________________________
-	previous assessment of language knowledge in order to enroll to the Master Degree: NO □ YES □
-	other (please specify for ex. Mother tongue, lectorship etc..): __________________________ 

SPANISH
-	any:  □
-	examination (mark): _________ (and/or passed) NO □ – YES □ 
-	certificates: NO □ – YES □ (if yes, attaching the certificate is mandatory)
-	previous study experience(s) abroad: NO □ – YES □ (if yes, please specify where)
_______________________________________________________________________
-	previous assessment of language knowledge in order to enroll to the Master Degree: NO □ – YES □
-	other (please specify for ex. Mother tongue, lectorship etc..): __________________________ 
-		

PORTUGUESE
-	any:  □
-	examination (mark): _________ (and/or passed) NO □ – YES □ 
-	certificates: NO □ – YES □ (if yes, attaching the certificate is mandatory)
-	previous study experience(s) abroad: NO □ – YES □ (if yes, please specify where)
_______________________________________________________________________
-	previous assessment of language knowledge in order to enroll to the Master Degree:  NO □ – YES □
-	other (please specify for ex. Mother tongue, lectorship etc..): __________________________