ERASMUS STUDENT

  ERASMUS STUDENT

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  ERASMUS STUDENT

helb offices contacts - APPLICATION FORM -  Academic year 2016/2017


Family name :


First name :



Home (Sending) Institution
Name of Institution
ERAMUS ID Code   
Institutional International Coordinator
Name   
Telephone   
E-mail   
Address   
Study period     Autumn Semester     Spring Semester
Duration of stay in months   
Intended month of arrival   
Intended month of departure   
Host (Receiving) Institution
Name of Institution
ERASMUS ID Code    Haute Ecole Libre de Bruxelles - Ilya Prigogine
B BRUXEL 85
Director International Relations Unit
Name    Michael ROBERT
Telephone    +32 2 560.29.13
E-mail    erasmus@helb-prigogine.be

Address    Route de Lennik 808  - Bâtiment P - P.7.117 - 1070 Bruxelles
Tel  +32.2.560.29.13 Fax   +32.2.560.28.38




Student’s Personal Data

First name   
Family name   
Date of birth   
Gender      Female        Male
Citizenship/Nationality   

Current address
   
Telephone/Cell Phone   
E-mail   
Person(s) to contact in case of emergency:
Name/Address/Telephone - including area code/ relationship to applicant
   
Any disability/special needs, if any please describe   


Degree which you are currently studying (study duration)...   

Year of study during your Erasmus stay (ex. Bac.3)   

Have you ever studied abroad?
If yes, please state when, where and name of institution, city and country
   
We strongly recommend attending cultural/language course before attending studying abroad
Language Competence
Rate your language skills as “excellent”, “good” or “poor”. Include all languages in which you have some competence. Also indicate your native language.
Language    Reading    Writing    Speaking
           
           
           
Please enclosed :
•    Your Transcript of Records (last one available)
•    A personal photo (ID size - jpg)
•    Photocopy of the identity card
•    Your national number :  ……………………………………..

I certify that all the information provided in this Application Form is correct and complete to the best of my knowledge.
   
Student’s signature
    Date





LEARNING AGREEMENT FOR TRAINEESHIPS

The Trainee
Last name (s)
        First name (s)
   
Date of birth        Nationality    
Sex [M/F]        Academic year   
Study cycle
        Subject area,
Code
   
Phone
        E-mail   

The Sending Institution
Name         Faculty
   
Erasmus code
(if applicable)
        Department
   
Address        Country,
Country code    
Contact person
name        Contact person
E-mail / phone   

The Receiving Organisation/Enterprise
Name
Sector         Department   
Address, website        Country   
Size of enterprise            
Contact person 
name / position        Contact person
e-mail / phone   
Mentor  name / position
        Mentor e-mail / phone   


For guidelines, please look at Annex 1, for end notes please look at Annex 2. 

Section to be completed BEFORE THE MOBILITY
I.    PROPOSED MOBILITY PROGRAMME                                                                           
Planned period of the mobility: from [month/year] ….……. till [month/year] …………

Number of working hours per week: …

Traineeship title: …

Detailed programme of the traineeship period…

Knowledge, skills and competences to be acquired by the trainee at the end of the traineeship …

Monitoring plan …

Evaluation plan  …


Language competence of the trainee
The level of language competence  in ………….. [workplace main language] that the trainee already has or agrees to acquire by the start of the mobility period is:
A1      A2      B1      B2      C1      C2 

The sending institution
The institution undertakes to respect all the principles of the Erasmus Charter for Higher Education relating to traineeships.
[Please fill in only one of the following boxes depending on whether the traineeship is embedded in the curriculum or is a voluntary traineeship.]
The traineeship is embedded in the curriculum and upon satisfactory completion of the traineeship, the institution undertakes to:
•    Award …….. ECTS credits.
•    Give a grade based on: Traineeship certificate   Final report   Interview  
•    Record the traineeship in the trainee's Transcript of Records.
•    Record the traineeship in the trainee's Diploma Supplement (or equivalent).
•    Record the traineeship in the trainee's Europass Mobility Document Yes   No  

The traineeship is voluntary and upon satisfactory completion of the traineeship, the institution undertakes to:
•    Award ECTS credits:  Yes   No  
If yes, please indicate the number of ECTS credits: ….
•    Give a grade: Yes   No  
If yes, please indicate if this will be based on:
Traineeship certificate   Final report   Interview  
•    Record the traineeship in the trainee's Transcript of Records Yes   No  
•    Record the traineeship in the trainee's Diploma Supplement (or equivalent), except if the trainee is a recent graduate.
•    Record the traineeship in the trainee's Europass Mobility Document Yes   No     This is recommended if the trainee will be a recent graduate.

The receiving organisation/enterprise
The trainee will receive a financial support for his/her traineeship:  Yes   No 
If yes, amount in EUR/month: ….   
The trainee will receive a contribution in kind for his/her traineeship:  Yes   No 
If yes, please specify: ….
Is the trainee covered by the accident insurance?  Yes   No 
If not, please specify whether the trainee is covered by an accident insurance provided by the sending institution: Yes   No 
The accident insurance covers:
-    accidents during travels made for work purposes:  Yes   No 
-    accidents on the way to work and back from work:  Yes   No 
Is the trainee covered by a liability insurance?  Yes   No 
The receiving organisation/enterprise undertakes to ensure that appropriate equipment and support is available to the trainee.
Upon completion of the traineeship, the organisation/enterprise undertakes to issue a Traineeship Certificate by …. [maximum 5 weeks after the  traineeship].

II.    RESPONSIBLE PERSONS
Responsible person  in the sending institution :
Name:   
Phone number:    E-mail:   

Responsible person  in the receiving organisation/enterprise (supervisor):
Name:        Function:   
Phone number:    E-mail:   

III. COMMITMENT OF THE THREE PARTIES
By signing this document, the trainee, the sending institution and the receiving organisation/enterprise confirm that they approve the proposed Learning Agreement and that they will comply with all the arrangements agreed by all parties.
The trainee and receiving organisation/enterprise will communicate to the sending institution any problem or changes regarding the traineeship period.

The trainee
Trainee’s signature         Date:   


The sending institution


Responsible person’s signature         Date:    
The receiving organisation/enterprise


Responsible person’s signature         Date:   


Section to be completed DURING THE MOBILITY
EXCEPTIONAL MAJOR CHANGES TO THE ORIGINAL LEARNING AGREEMENT

I. EXCEPTIONAL CHANGES TO THE PROPOSED MOBILITY PROGRAMME
Planned period of the mobility: from [month/year] ….……. till [month/year] …………
Number of working hours per week: …
Traineeship title: …
Detailed programme of the traineeship period…

Knowledge, skills and competences to be acquired by the trainee at the end of the traineeship …

Monitoring plan …

Evaluation plan  …


The trainee, the sending institution and the receiving organisation/enterprise confirm that the proposed amendments to the mobility programme are approved.
Approval by e-mail or signature from the trainee, the responsible person in the sending institution and the responsible person in the receiving organisation/enterprise.

II.     CHANGES IN THE RESPONSIBLE PERSON(S), if any:
New responsible person in the sending institution:
Name:        Function:   
Phone number:        E-mail:   

New responsible person in the receiving organisation/enterprise:
Name:        Function:   
Phone number:        E-mail:   

Section to be completed AFTER THE MOBILITY
TRAINEESHIP CERTIFICATE
Name of the trainee :

Name of the receiving organisation/enterprise :


Sector of the receiving organisation/enterprise :

Address of the receiving organisation/enterprise [street, city, country, phone, e-mail address], website:

Start and end of the traineeship:
from [day/month/year]    …………….    till [day/month/year]    …………….

Traineeship title:

Detailed programme of the traineeship period including tasks carried out by the trainee:




Knowledge, skills (intellectual and practical) and competences acquired (learning outcomes achieved):




Evaluation of the trainee:

Date:

Name and signature of the responsible person at the receiving organisation/enterprise :             


Annex 1: Guidelines
The purpose of the Learning Agreement is to provide a transparent and efficient preparation of the traineeship period abroad and to ensure that the trainee will receive recognition for the activities successfully completed abroad.  
It is recommended to use this template. However, if the higher education institution already has an IT system in place to produce the Learning Agreement or the Transcript of Records, it can continue using it. The Traineeship Certificate that the receiving organisation/enterprise must issue may have a different format as well. What is important is that all the information requested in this template is provided, no matter in which format
How to use this Learning Agreement:
Before the mobility, it is necessary to fill in page 1 with information on the trainee, the sending institution and the receiving organisation/enterprise and the three parties have to agree on the section to be completed before the mobility (pages 2 and 3).
On page 1, all the information mentioned will have to be encoded in the Mobility Tool. The sending institution can decide to add more information (e.g. additional contact person in the coordinating institution of a consortium) or to request less in case some of the information is already provided in other documents internal to the institution. However, it should at least include the names of the sending institution and the receiving organisation/enterprise and names and contact details of the trainee, the persons of contact and the mentor in the receiving organisation/enterprise.
The section to be completed during the mobility (page 4) should only be used if there are changes in the responsible persons or in case it is necessary to introduce changes to the original traineeship programme. This section and the section before mobility (pages 1 to 4) should always be sent together in all communications.
After the mobility, the receiving organisation/enterprise should send a Traineeship Certificate to the student within a maximum of 5 weeks after successful completion of the traineeship (page 5). Finally the sending institution should issue a Transcript of Records if the traineeship is embedded in the curriculum or if it had committed to do so before the mobility (a record of the results in a database accessible to the student is also acceptable).

PROPOSED MOBILITY PROGRAMME
The proposed mobility programme includes the indicative start and end months of the agreed traineeship that the student will carry out abroad.
The Learning Agreement must comprise the number of working hours per week and a detailed programme of the traineeship period, including, tasks/deliverables and associated timing to be carried out by the trainee.
In addition, the proposed mobility programme must foresee the knowledge, skills (intellectual and practical) and competences to be acquired by the trainee at the end of the traineeship (learning outcomes).
A monitoring plan will describe how and when the trainee will be monitored during the traineeship by both the sending institution and the receiving organisation/enterprise. It must specify the number of supervision hours and whether a third party is also involved, such as a higher education institution in the receiving country. If it is the case, the monitoring plan will also specify the contact details of the person in charge responsible for the supervision of the trainee in that institution.
Finally, the proposed mobility programme must include an evaluation plan describing the assessment criteria to be used to evaluate the traineeship period. Examples of assessment criteria: academic skills/expertise, analytical skills, initiative, adaptability, communication skills, teamwork skills, decision-making skills, ICT skills, innovative and creative skills, strategic-organisational skills, foreign language skills.
A recommended level of language competence in the main language of work should be agreed with the receiving organisation/enterprise to ensure a proper integration of the trainee in the organisation/enterprise. The trainee will then commit to reach this level of language competence by the start of the study period. The level of the trainee will be assessed after his/her selection with the Erasmus+ online assessment tool when available (the results will be sent to the sending institution) or else by any other means to be decided by the sending institution. In case the trainee would not already have this level when signing the Learning Agreement, he/she commits to reach it with the support to be provided by the sending institution (either with courses that can be funded by the organisational support grant or with the Erasmus+ online tutored courses).
The sending institution commits to recognise the learning outcomes of the traineeship upon satisfactory completion of the mobility programme. There are different provisions for traineeships embedded in the curriculum (obligatory traineeships) and for voluntary traineeships.
In the case of traineeships embedded in the curriculum, the sending institution commits to record the traineeship in the trainee's transcript of Records and Diploma Supplement. The sending institution has to specify the number of ECTS credits that will be granted and the modalities for setting the grade. These elements are optional for voluntary traineeships and, recording the grade in the trainee's Europass Mobility Document, is optional for both kinds of traineeships. However, in the case of voluntary traineeships carried out by recent graduates, recording the traineeship in the trainee's Europass Mobility Document is highly recommended.
The trainee must be covered at least by an accident insurance (at least for damages caused to the trainee at the workplace) and by a liability insurance at work (for damages caused by the trainee at the workplace). The receiving organisation/enterprise will commit to grant the trainee a minimum insurance coverage, unless he or she is insured by the sending institution or himself.
The receiving organisation/enterprise will ensure that appropriate equipment and support are available to the trainee and it will specify whether the trainee will receive a financial support and/or a contribution in kind for the traineeship, which are compatible and the Erasmus+ grant.
Finally, upon completion of the traineeship, the organisation/enterprise undertakes to issue a Traineeship Certificate corresponding to the section After the Mobility. This document should be provided within a maximum of 5 weeks after the traineeship to the trainee and to the sending institution.
All parties must sign the section before the mobility; however, it is not compulsory to circulate papers with original signatures, scanned copies of signatures or digital signatures may be accepted, depending on the national legislation.

CHANGES TO THE ORIGINAL LEARNING AGREEMENT
The section to be completed during the mobility is needed only if changes have to be introduced into the original Learning Agreement. In that case, the section to be completed before the mobility should be kept unchanged and changes should be described in this section.
When changes to the mobility programme arise, they should be agreed as soon as possible with the sending institution.
In case the change concerns an extension of the duration of the mobility programme abroad, the request can be made by the trainee at the latest one month before the foreseen end date.
All parties must confirm that the proposed amendments to the Learning Agreement are approved. For this specific section, original or scanned signatures are not mandatory and an approval by email may be enough. The procedure has to be decided by the sending institution, depending on the national legislation.

TRAINEESHIP CERTIFICATE
Upon completion of the traineeship, the receiving organisation/enterprise commits to provide to the sending institution and to the trainee a Traineeship Certificate within a period agreed in the section before the mobility, which will be of a maximum 5 weeks after completion of the traineeship.
The Traineeship Certificate will contain all the elements that are requested in page 5. The actual start and end dates of the traineeship programme must be included according to the following definitions:
-    The start date of the traineeship period is the first day the trainee has been present at the enterprise to carry out his/her traineeship. It can be the first day of work, or of a welcoming event organised by the receiving organisation/enterprise or of language and intercultural courses.
-    The end date of the traineeship period is the last day the trainee has been present at the receiving enterprise to carry out his/her traineeship (and not his actual date of departure).
Following the receipt of the Traineeship Certificate, the sending institution commits to issue a Transcript of Records if the traineeship was embedded in the curriculum or if it had committed to do so before the mobility. The sending institution will provide to the trainee the Transcript of Records normally within five weeks and without further requirements than those agreed upon before the mobility. Therefore, when it was foreseen to recognise the traineeship with a certain number of ECTS, there should not be further requirements in this regard; however, the trainee may have to write a final report or undergo an interview only for the purposes of setting a grade (if it was initially requested in the Learning Agreement).
The Transcript of Records will contain at least the information that the sending institution committed to provide before the mobility in the Learning Agreement (a record of it in a database accessible to the student is also acceptable).
In addition, the traineeship will be recorded in the trainee's Diploma Supplement, except when the trainee is a recent graduate. In that case, it is recommended to record the traineeship in the trainee's Europass Mobility Document and it should in every case be done if the sending institution committed to do so before the mobility.

Steps to fill in the Learning Agreement for Traineeships
Page 1 – Information on the student and the sending and receiving organisation/enterprise



Before mobility   
Pages 2-3                               


                               



During mobility
Page 4




   

After mobility
Page 5


Annex 2: End notes 



  Nationality: Country to which the person belongs administratively and that issues the ID card and/or passport.
  Study cycle: Short cycle (EQF level 5) / bachelor or equivalent first cycle (EQF level 6) / master or equivalent second cycle (EQF level 7) / doctorate or equivalent third cycle (EQF level 8) – for recent graduates, specify the latest study cycle.

  The ISCED-F 2013 search tool available at http://ec.europa.eu/education/tools/isced-f_en.htm should be used to find the ISCED 2013 detailed field of education and training that is closest to the subject of the degree to be awarded to the trainee by the sending institution.
  Country code: ISO 3166-2 country codes available at: https://www.iso.org/obp/ui/#search.
  The list of top-level NACE sector codes is available at:
http://ec.europa.eu/eurostat/ramon/nomenclatures/index.cfm?TargetUrl=LST_NOM_DTL&StrNom=NACE_REV2&StrLanguageCode=EN.

  The size of the enterprise could be, for instance, 1-50 / 51-500 / more than 500 employees.
  Contact person: a person who can provide administrative information within the framework of Erasmus traineeships.
  Mentor: the role of the mentor is to provide support, encouragement and information to the trainee on the life and experience relative to the enterprise (culture of the enterprise, informal codes and conducts, etc.). Normally, the mentor should be a different person than the supervisor.
  For the Common European Framework of Reference for Languages (CEFR) see http://europass.cedefop.europa.eu/en/resources/european-language-levels-cefr
  Responsible person in the sending institution: this person is responsible for signing the Learning Agreement, amending it if needed and recognising the credits and associated learning outcomes on behalf of the responsible academic body as set out in the Learning Agreement.
  Responsible person in the receiving organisation (supervisor): this person is responsible for signing the Learning Agreement, amending it if needed, supervising the trainee during the traineeship and signing the Traineeship Certificate.


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