Erasmus+ before the mobility form for scholarship winners for 2020/2021

1.DECLARATION OF STATUS AT EÖTVÖS LORÁND UNIVERSITY

I

First Name

Second name

Neptun code

Faculty

Field of Studies

who am studying at ELTE, hereby declare that

(for Studies and for Traineeships) I agree to the fact that I must have active student status at Eötvös Loránd University from the starting date and throughout my Erasmus+ mobility period otherwise I lose my Erasmus+ status and must refund my Erasmus+ grant to Eötvös Loránd University.

(for Traineeship after graduation) I agree to the fact that I must finish my Erasmus+ traineeship after degree mobility in 1 year (12 months) after my graduation otherwise I am not eligible to the scholarship.

2. DECLARATION ON THE PLANNED START AND END OF MOBILITY AND THE MANDATORY QUARANTINE

I. I hereby declare that the mobility period includes a period of quarantine:

Yes

No

II. I hereby declare that the mobility includes an online teaching period:

Yes

No

III. I hereby declare that

I have provided the start and end dates of the mobility (within this: mandatory quarantine, online teaching period, physical period) at section 5. of this questionnaire according to the academic/work schedule provided by the receiving institution, and based on available information (website, e-mail notification) regarding the mandatory quarantine period, and I can prove this if it becomes necessary.

3. DECLARATION OF OLS ASSESSMENT

I hereby declare that

I have a completed OLS assessment.

4.DECLARATION ON PROMOTION ACTIVITY

Outgoing students for the 2020/21 academic year will have the opportunity to participate in the promotion of the Erasmus + program within the framework of Eötvös Loránd University by sharing their experiences gained during the Erasmus + scholarship period.

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

Personal experience report (Presentation at Erasmus+ promotion events, information days)

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

Video experience report

Article experience report (with pictures)

Blog/Vlog about the mobility period

Guided written experience report (with help of guided questions, topics)

Quick interview

Share a professional publication related to the Erasmus+ studies / traineeship

5. DATA DECLARATION OF THE GRANT AGREEMENT

Date of birth

Sex

Citizenship

Permanent address:

Country

Zip code

Municipality

Address (street suffix, number, floor, door, etc. ..)

Place of residence in Hungary (if the permanent address is not in Hungary)

Phone number

E-mail address (one that you use)

Study cycle (during the mobility)

Number of completed years of higher education (whole number)

Year of study (in the given study cycle)

Previous participation in an Erasmus+ mobility, rounded to a whole month (only in the given study cycle)

Type of mobility:

Field of studies

Field of Studies with 4 digit ISCED code

OM number

The start date of the mandatory quarantine within the mobility (if there is one)

The end date of the mandatory quarantine within the mobility (if there is one)

The start date of the virtual period within the mobility (if there is one)

The end date of the virtual period within the mobility (if there is one)

The start date of the physical period within the mobility

The end date of the physical period within the mobility

Place of mobility (country)

Place of mobility (city)

Erasmus-code (for mobilities with study purposes and for internships at a university), or the name of the receiving institution/company (for internships)

Bank account holder's name

Bank name

Clearing/BIC/SWIFT code (Bank identification code)

Account number with IBAN-code

Currency of the Bank Account:

Health insurance – company name and number of the insurance:

Liability insurance – company name and number of the insurance (for internships):

Accident insurance – company name and number of the insurance (for internships):

Language of the OLS assessment

Result of the OLS assessment