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FRM_SSW16


Learning Agreement for Huji - Outgoing Exchange Students
Student's Details
Last name:First name:Nationality:
Date of birth:Sex:Degree:
DD/MM/YYYY
Faculty:Department 1:Department 2:
Phone:Address:E-mail:

The Hosting Institution
Name of Institution:Country:Faculty:
Department:Contact person Name:E-mail / Phone:
Do you have additional required courses you need to complete in the fourth year?
If yes, indicate which


Proposed Programme
Planned period of the mobility: from [month/year]till [month/year]
Study programme abroad:
Course #:Course title*:Semester:Credits**:Equivalent Course at HUJI:Possible Credits at HUJI:Department Recognition:
*As indicated in the course catalogue at the hosting institution
**Number of credits to be awarded by the hosting institution upon successful completion

Web link to the course catalogue at the receiving institution describing the learning outcomes:

I confirm that the information above is correct and accurate
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The sending institution
Departmental coordinator’s signatureInstitutional coordinator’s signature
____________________________________________________________________________
Date:Date:



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