1. ŠIAULIAI UNIVERSITY
Department of International Programmes and Relations
Vilniaus st. 88, LT-76285 Šiauliai, Lithuania
Tel: +370 41 595742, Fax: +370 41 595743
E-mail: urs2@cr.su.lt
WEB: http://www.su.lt/en/siauliai-university-su
Application form for Exchange Studies
Important information
● Application Deadline:
 Autumn semester - June 1
 Spring semester - November 30
● Please type or use block letters. Answer all questions fully.
● Return your completed application form, documentation by the
application deadline (address is above).
● Only typewritten applications will be accepted
Recent photo
1. Sending Institution
Name
Full address
Department Coordinator
Contact information
Institutional Coordinator
Contact information
2. Personal information
Family (last) name
Date of Birth
(dd-mm-yyyy)
Citizenship
Passport/ID No.
- -
First name (s)
Place of Birth
Sex
Valid
Male
Female
from till
3. Applicant contact information
Current address:
House and Street
City
Postal code
Country
Mailing address
E-mail address
Telephone number
Permanent address:
House and Street
City
Postal code
Country
4. Person to contact in case of emergency
Family (last) name
Relationship to You
First name (s)
Telephone number
1

2.
Address
E-mail address
5. Language proficiency
Mother tongue
Other languages
English:
:
Language of instruction at school, if different
Russian:
French:
E - excellent, G-good, F- fair
Have You taken the TOEFEL or IELTS?
If “YES” then what was your score?
If “NO” then indicate your English
proficiency
Speaking:
Yes
Date passed:
Reading:
No
Writing:
E - excellent, G-good, F- fair
6. Current study
Degree for which you are currently studying
Undergraduate
Number of study semesters prior departure abroad
Postgraduate
7. Financial information
Please, specify your funding resources for tuition and accommodation
Parents
Personal
Doctorate
Scholarship
Other
8. Duration of study period at Šiauliai University
Type of mobility
ERASMUS
University bilateral agreement
Academic year
Choose:
Autumn semester: September 1 - December 20
Spring semester: February 1 - June 15
All academic year: September 1 - June 15
Other period: from to
9. Curriculum you apply for at Šiauliai University
List of study subjects for exchange applicants: http://www.su.lt/en/studies/exchange-programmes2
Course code
Course unit title
Semester
(autumn/spring)
Number of
ECTS credits
2

3. 10. Required enclosures
Please, ensure that the application is complete and that it includes the following items:
Motivation letter
Copy of passport (for non EU citizens) or ID card (only for EU and EEA citizens)
I confirm that information I have provided in this application and in any attached document is
true and correct (print and sigh this document).
Signature of applicant
Date (dd.mm.yyyy)
SENDING INSTITUTION
We confirm that the proposed programme of study agreement is approved.
Departmental coordinator
Institutional coordinator’s signature
Name, surname,
signature
Name, surname,
signature
Date
Date
RECEIVING INSTITUTION
We hereby acknowledge receipt of the application and confirm that this proposed programme of
study agreement is approved.
Departmental coordinator
Institutional coordinator’s signature
Name, surname,
signature
Name, surname,
signature
Date
Date
3