ࡱ> egd bjbj 8> LLLLL````$`(@@@@[]]]]]]$jLLL@@333 L@L@[3[333@(c<%:3G034_:4334LG34$ : Universit libre de bruxelles, universit d'europe  Dpartement enseignement - Service de Mobilit Etudiante  HYPERLINK "mailto:Elizabeth.Olivares.Fontt@ulb.ac.be" Elizabeth.Olivares.Fontt@ulb.ac.be EXCHANGE PROGRAMS Application form 2015-2016 Programmes dechanges FORMULAIRE de candidature 2015-2016 CREPUQ - BILATERAL AGREEMENTS / CREPUQ - CONVENTIONS BILATERALES To be sent, by email, with the required scanned documents on 31 March 2015 the latest (for any mobility starting in September 2015 or in February 2016), exclusively in the field of our existing agreements Formulaire et annexes scanns, envoyer par email, au plus tard pour le 31 mars 2015 (pour les sjours qui commencent au 1er septembre 2015 ou en fvrier 2016) exclusivement dans le cadre de nos accords dEchanges existants. FAMILY NAME:..GIVEN NAME: Gender: ( F ( M Birthday (DD/MM/YYYY): _ _ / _ _ / _ _ _ _ Birthplace (city and country) Nationality Permanent address (where we will be able to join you until your arrival): ... E-mail address: Home university: Field of study: Foreseen period of the stay: ( Academic year (Mid September to the end of June) ( 1st Term (Mid September to the end of January) ( 2nd Term (Early February to the end of June) Documents to join to this form (no standard required) / Documents joindre ce formulaire (format libre) ( an official list of the results obtained so far at your university; ( a provisional list of the courses you wish to study in ULB, mentioning both codes and titles, approved by your academic coordinator at home university [courses to pick in our 14-15 program:  HYPERLINK "http://www.ulb.ac.be/programme" http://www.ulb.ac.be/programme. Please note that you should take at least 60% of the courses, in the main Faculty where you will be registered in. ( a copy of your ID or passport; ( a digital ID picture (photo) format jpg - 2cm x 2,4cm ( Optional: a personalized recommendation letter by an academic authority from your university. 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