Erasmus+ Outgoing Student Participation/Waiver Form

PERSONAL INFORMATION

ADVERTISEMENT NUMBER AND NAME*

Turkish National Identity Number / Foreign National Identity Number*

NAME*

SURNAME*

TYPE OF MOBILITY*
—Lütfen bir seçenek seçin—KA131 SMS (Intra-European Learning Mobility)KA131 SMP (Intra-European Traineeship Mobility)KA171 SMS (Non-European Learning Mobility)KA171 SMP (Non-European Traineeship Mobility)

MOBILITY PARTICIPATION STATUS*
—Lütfen bir seçenek seçin—I declare that I will participate.I waive my right (I will not participate)

DATE OF BIRTH*

BIRTHPLACE*

INSTITUTE/FACULTY/VOCATIONAL SCHOOL/HIGHER EDUCATION INSTITUTION*

SECTION*

EDUCATION LEVEL*
—Lütfen bir seçenek seçin—LICENCEASSOCIATE DEGREEDEGREEDOCTORATE

CLASS*
—Lütfen bir seçenek seçin—PREPARATION123456GRADUATE SCIENTIFIC PREPARATIONACADEMIC YEARTHESIS PERIOD

STUDENT NUMBER*

PHONE NUMBER*

EMAIL ADDRESS*

ADDRESS*

II. EMERGENCY CONTACT PERSON INFORMATION

NAME SURNAME*

DEGREE OF CLOSENESS*

PHONE NUMBER*

EMAIL ADDRESS*

ADDRESS*

III. DECLARATION*

I declare that I will have a course load of 30 ECTS credits for each academic semester in which I am eligible for learning mobility.

I declare that if I withdraw, I will not participate in the Erasmus+ Student Mobility program to which I have been awarded.

Based on the aforementioned points, I acknowledge and declare that the announced placement result is not binding on the SCU Erasmus+ Institutional Coordination Office, and that my ability to benefit from the mobility program depends on the budget of the SCU Erasmus+ Coordination Office.

My data within the scope of the Law No. 6698 on the Protection of Personal Data I consent to the processing of my personal data as described in the Explicit Consent Form.

*Students being selected to participate in the Erasmus+ Student Learning Mobility Program does not guarantee that they will actually benefit from this mobility activity. Students who are selected and announced on the main/reserve list will only be able to participate in this activity in accordance with the budget provided by the National Agency to the Sivas Cumhuriyet University Erasmus+ Institutional Coordination Office.

SIGNATURE

Security Verification