Mobility Form for an Internship

Please fill out all the information below concerning your internship abroad.

Your information

Title

Name

First name

School

Campus

Current year of study

Program

Phone number

Dates of your internship (do not mention travel dates)

Starting date

Ending date

Please upload your filled and signed internship agreement *

Agreement

Would you like to apply for an Erasmus+ scholarship *

Answer

Yes No

Contact in case of emergency :

Name

First name

Phone number

Host company

Name of the company

Address

City

Postal Zip code

Country

Phone number

Your tutor

Name

First name

Phone number

Will the host company provide you with a financial compensation ?

Answer

Yes No

If so, how much (EUR/month) ?

Answer

Will the host company provide you with incentives ?

Answer

Yes No

If so, how much (EUR/month) ?

Answer