To Erasmus+ Coordination Unit at the University of……….. and Ca’ Foscari University of Venice

APPLICANT’S DETAILS	
Surname 

(as indicated in Passport or Identity card)	First name:

(as indicated in Passport or Identity card)	
Date of birth: (dd/mm/yyyy)	City and Country of birth:	
Nationality:	Gender: (M/F)	
Home Address: 
(please indicate your full address: Address, Town, Post/Zip Code)		
Document: (passport or ID card)	ID card or passport number 
Date of Expiry	
Telephone Number:
Mobile Number:	E-mail Address:	
Do you require Disability or Learning Support?     	Yes ☐     No ☐	

HOME UNIVERSITY	
Home University:		
Title of your current degree programme (FOR STUDENTS)/
Current position at the partner university (FOR ACADEMIC AND ADMINISTRATIVE STAFF):		
FOR STUDENTS ONLY:
Level of your current degree programme (1st cycle/1st level/undergraduate; 2nd cycle/2nd level/Master; 3rd cycle/3rd level/PhD):		
FOR STUDENTS ONLY:
Number of years of higher education (university) study completed to date (at which year of your current course programme you are enrolled):		
FOR STUDENTS ONLY:
Previous experiences of mobility under Erasmus Mundus and Erasmus+ ICM Programmes (please detail University of destination, place and duration)		

PROPOSED PROGRAMME OF STUDY/TEACHING/ TRAINING AT UNIVE	
Duration of stay (n° of months/days):		
☐	Autumn term (from September 2023)
☐	Spring term (from February 2024)
		
MOTIVATION 
(max 5000 characters including spaces) explaining the background of the candidate and the reasons for applying to the programme		

The undersigned is willing to apply for the Erasmus+ - International Credit Mobility grant to Ca’ Foscari University of Venice, according with the call for applications published by the University of ……………….on ……….. with the following deadline: ……………………….

Compulsory attachments:

For student candidates:

	Application form duly filled in and signed;
	Copy of a valid ID card or passport;
	Copy of a proof of registration at a Bachelor/Master/PhD programme at the partner University (e.g. certificate of enrollment);
	Copy of the transcripts of records, indicating university grades/marks for finished and/or current cycles of study;
	Copy of official language certifications (if any) or self-certifications of language qualifications;
	Proposed Learning Agreement (for 1st and 2nd cycle students)/Mobility Programme (3rd cycle students), signed by the applicant, the Erasmus+ Administrative Coordinator and Erasmus+ Academic Coordinator or Coordinator of the Student’s Study Programme of the sending institution; 
	For PhD students only: letter of interest signed by the prospective academic supervisor/Head of Department at Ca’ Foscari University of Venice stating the availability and willingness to supervise the applicant. In order to get this, applicants MUST contact in due time international.cooperation@unive.it (providing a CV and a research plan);   
	Curriculum Vitae (max 2 pages) in English, including extracurricular activities (courses, seminars, conferences, published research, etc.) and professional experience related to the fields of knowledge of the courses;
	Proof of less advantaged background (if applicable);
	Other supporting documents in English, if relevant, e.g. honours, awards, internship/work certificates.

For academic and administrative staff candidates:

	Application form duly filled in and signed;
	Copy of a valid ID card or passport;
	Copy of a proof of employment at the partner University (ex. certificate issued by the Home University stating he/she is Academic/Administrative staff employed at the University);
	Mobility Programme signed by the applicant and by the E+ Administrative Coordinator and Academic Coordinator;
	Letter of interest signed by the prospective academic supervisor or Head of Department (for academic staff) at Ca’ Foscari University of Venice or by the administrative supervisor (for administrative staff) stating the availability and willingness to collaborate with the applicant. In order to get this, applicants MUST contact in due time international.cooperation@unive.it (providing a CV and a work plan);   
	Curriculum Vitae (max. 2 pages) in English including extracurricular activities (courses, seminars, conferences, published researches etc.) and professional experience related to the fields of knowledge of the courses;
	If relevant, one letter of recommendation (max. 1 page) written by academics, researchers or by professionals who have participated in the candidate’s academic or professional training, completed with their email and phone numbers and the at least another referee‘s contact details.

SIGNATURE OF APPLICANT	
I confirm that the information provided on this application form is correct.	
Signature: 

	Place and Date: