STUDENT APPLICATION FORM




....: Fields selected on red colour are obligatory :....
Please use English letters only!
SENDING INSTITUTION
Sending Institution 

Sending Institution

Institutional Coordinator surname and first name 

Institutional Coordinator surname and first name

 

phone  

phone

 

Institutional Coordinator fax 

fax

 

Institutional Coordinator email 

email

 

Departmental coordinator surname and first name 

Departmental coordinator surname and first name

 

Institutional Coordinator phone  

phone

 

fax 

fax

 

Institutional Coordinator email 

email

 

STUDENT'S PERSONAL DATA
Family name 

Student family name

First name 

 Student first name

Date of birth(2009-01-01)) 

Student date of birth(like DD-MM-YYYY)

Place 

 Student place of birth

Select 

Student gender

NATIONALITY 

Student nationality

Fill your address 

Student current address.

Street:

Zip code:

City:

Country code (PL, SE, UK, …):

WprowadĽ nazwę miasta 

Student phone

Student email 

Student email

Passport / Identity Card 

Passport/Identity Card number

 

Student permanent address (if different)

 

Phone 2 

Second phone

 

Mother's name

 

Father's name

STUDY PERIOD
Select 

Study period (semester)

Student arrival 

Date of arrival (DD-MM-YYYY)

Student arrival 

Field of study

Student arrival 

Level of study

LANGUAGE COMPETENCE
English 

English - I am currently studying this language

 

English 2 

English - I have sufficient knowledge to follow lectures

 

English 3 

English - I would have sufficient knowledge to follow lectures if I had some extra preparation

 

Polish 1 

Polish - I am currently studying this language

 

Polish 2 

Polish - I have sufficient knowledge to follow lectures

 

Polish 3 

Polish - I would have sufficient knowledge to follow lectures if I had some extra preparation

 

PREVIOUS AND CURRENT STUDY
Subject 

Diploma/degree for which you are currently studying

 

Years of study 

Number of higher education study years prior to departure abroad:

 

Study abroad 

Have you already been studying abroad?

 

Study abroad 

If Yes, when ? at which institution ?

 

DETAILS OF THE PROPOSED STUDY PROGRAMME ABROAD

In the academic year 2012/2013, the University of Technology and Life Sciences offers below courses - which can be studied full-time at the undergraduate level.

Indicators: FS – Fall semester; SS – Spring semester; FY – Fall and Spring semester

 subject 

1.Course ECTS credits

 subject 

2.Course ECTS credits

 subject 

3.Course ECTS credits

 subject 

4.Course ECTS credits

 subject 

5.Course ECTS credits

 subject 

6.Course ECTS credits

 subject 

7.Course ECTS credits

 subject 

8.Course ECTS credits

Accomodation 

University Hall of Residence:


  Please send the original printed papers to Institutional Coordinator. The adress is at the bottom of PDF file genreted after processing this form.