LIFELONG LEARNING PROGRAMME Application Form Diploma Supplement (DS) Label Academic years 2009 – 2013 (four years) Please give the full and accurate reference of your ERASMUS University Charter: -IC-1-year-1- -ERASMUS- -1 CLOSING DATE FOR SUBMISSION: 15 January 2009 (as per postmark) Applications bearing a postmark after this date will not be considered. It is strongly recommended to send the application by means that provide you with proof of dispatch (registered post, express courier, etc.). One complete original version of the application duly signed by the Legal Representative of the applicant organisation and two copies are to be sent to: Dům zahraničních služeb MŠMT Národní agentura pro evropské vzdělávací programy (NAEP) pracoviště Senovážné nám. 24 116 47 Praha 1 Furthermore, one complete copy is to be sent to the National Agency email address (rudolf.sindelar@naep.cz) and must arrive no later than 15 January 2009 Application and selection procedure · This form is to be used if your institution wishes to apply for a Diploma Supplement (DS) Label that is valid for a period of four academic years (2009 - 2013) · The application form must be completed in one of the official languages of the European Union. · The DS Label can be applied for by an institution which has been awarded a Standard or an Extended Erasmus University Charter (Standard Charter and Student placements) until the end of the Lifelong Learning Programme. · The institution shall demonstrate that information about the issuing of the DS by the institution is made publicly available (on-line or hard copy). · The Diploma Supplement shall follow the standard model developed by the European Commission, Council of Europe and UNESCO (see annex or http://europa.eu.int/comm/education/policies/rec_qual/recognition/ds_en.pdf). · Applicants will receive an acknowledgement of receipt from the National Agency. · In accordance with standard Commission/Executive Agency practice, the information provided in your application may be used for the purposes of evaluating the Lifelong Learning Programme (LLP). The relevant data protection regulations will be respected. Any questions relating to this application should be addressed to Dům zahraničních služeb MŠMT Národní agentura pro evropské vzdělávací programy (NAEP) pracoviště Senovážné nám. 24 116 47 Praha 1 Section 1 - Identification 1.1 Languages Language in which you would like the label logo to be issued DE EN FR Language in which you would like correspondence with the Commission/Executive Agency DE EN FR 1.2 Applicant institution 1.2.1 Legal Representative (The same person as specified in the Erasmus University Charter application of your institution or as modified.) Full legal name of the institution in the national language Acronym of the institution, if applicable Full name of the Institution in English (formal or informal translation) Country code Region code ERASMUS ID code (e.g. B BRUXEL01) Website http:// Legal representative of the institution (head of the institution): Last and first name Title (optional) (e.g. Prof., Dr, etc.) Gender F (female) M (male) Department/Unit Official function within the institution Legal address of the institution Street Post code & town Country Phone (including country and area codes) + / / Fax (including country and area codes) + / / E-mail address @ Coordinator (The same person as specified in the Erasmus University Charter application of your institution or as modified) 1.2.2 Institutional DS Coordinator (if different from the legal representative) Institutional DS coordinator: Last and first name Title (optional) (e.g. Prof., Dr, etc.) Gender F (female) M (male) Department/Unit Official function within the institution Correspondence address: Street Post code & town Country Phone (including country and area codes) + / / Fax (including country and area codes) + / / E-mail address @ Section 2 - DOCUMENTS REQUIRED Please tick all applicable boxes below: Please note that applications that are incomplete and which do not provide all the information requested in the application form together with the required copies of the Diploma Supplement as specified in 2.1 below, will be considered ineligible. 2.1 Examples of Diploma Supplement issued Please note that no originals of Diploma Supplements should be submitted with the application, but only certified copies .If it is necessary to satisfy data protection requirements these may be anonymised. The following documents have to be provided in order to allow the assessment of the application for a DS label: q I enclose hard copies of completed, signed and certified Diploma Supplements. q Issued by my institution in 2007 or 2008. q To two students in different subject areas after completion of their first cycle studies. q To two students in different subject areas after completion of their second cycle studies. Only in case the applicant institution does not have two cycle programmes: q To four students after completion of their studies in different subject areas. Only in the case the applicant institution has less than four subject areas: q To four students after completion of their studies in all subject areas available at my institution. 2.2 Confirmation I confirm that: q The copies comply with the standard Diploma Supplement model developed by the European Commission/Council of Europe/UNESCO (http://ec.europa.eu/education/programmes/socrates/ects/doc/form4.pdf). q All students of the applicant institution receive a copy of the Diploma Supplement automatically and free of charge upon graduation. q The Diploma Supplement is issued in a widely spoken European language and, if so wished, in another language. q All the examples of Diploma Supplements enclosed with this application are certified copies of original, authentic Diploma Supplements, which were issued to students who have graduated from the applicant institution. 2.3 Public Information on the Diploma Supplement q Web pages I refer to the following web page(s) of my institution stating that the Diploma Supplement is being issued in a widely spoken European language, given automatically and free of charge to every student upon graduation, and including a filled-in example. http:// Section 3 - Declaration To be completed by the person legally authorised to sign on behalf of the applicant institution, as mentioned in section 1.2.1 “I, the undersigned, certify that the information contained in this application is correct to the best of my knowledge.” Place: Date / / (day/month/year) Signature of the Legal Representative Stamp of the institution (optional) Name and position in capitals NAME: POSITION: Checklist for the Application All questions have been answered The original version of the application form bears the original signature of the legal representative of the applicant institution. Two copies of the application form have also been provided. Four examples of Diploma Supplements issued to four students are enclosed The web page with public information on the Diploma Supplement is indicated ANNEX Diploma Supplement Model Checklist (Each Diploma Supplement should start with the following preamble): “This Diploma Supplement model was developed by the European Commission, Council of Europe and UNESCO/CEPES. The purpose of the supplement is to provide sufficient independent data to improve the international ‘transparency’ and fair academic and professional recognition of qualifications (diplomas, degrees, certificates etc.). It is designed to provide a description of the nature, level, context, content and status of the studies that were pursued and successfully completed by the individual named on the original qualification to which this supplement is appended. It should be free from any value judgements, equivalence statements or suggestions about recognition. Information in all eight sections should be provided. Where information is not provided, an explanation should give the reason why.” (And continue with the following eight sections): 1. Information identifying the holder of the qualification 1.1 Family name(s): 1.2 Given Name(s): 1.3 Date of birth (day/month/year): 1.4 Student identification number or code (if available): 2. Information identifying the qualification 2.1 Name of the qualification and (if applicable) title conferred: 2.2 Main field(s) of study for the qualification: 2.3 Name and status of awarding institution (in original language): 2.4 Name and status of institution (if different from 2.3) administering studies (in original language): 2.5 Language(s) of instruction/examination: 3. Information on the level of the qualification 3.1 Level of qualification: 3.2 Official length of programme: 3.3 Access requirements(s): 4. Information on the contents and results gained 4.1 Mode of study: 4.2 Programme requirements: 4.3 Programme details (e.g., modules or units studied), and the individual grades/marks/credits obtained (if this information is available on an official transcript this should be used here.): 4.4 Grading scheme and, if available, grade distribution guidance: 4.5 Overall classification of the qualification (in original language): 5. Information on the function of the qualification 5.1 Access to further study: 5.2 Professional status (if applicable): 6. Additional information 6.1 Additional information: 6.2 Further information sources: 7. Certification of the supplement 7.1 Date: 7.2 Signature: 7.3 Capacity: 7.4 Official stamp or seal: 8. Information on the national higher education system: (N.B. Institutions that intend to issue Diploma Supplements should refer to the explanatory notes that explain how to complete them).