uniwersytet śląski university of silesia

UNIWERSYTET ŚLĄSKI
UNIVERSITY OF SILESIA
KWESTIONARIUSZ ZGŁOSZENIOWY - LLP/ERASMUS
APPLICATION FORM - LLP/ERASMUS
ACADEMIC YEAR 2009/2010
Please, use block letters
Application deadlines:
Semester periods:
31st July 2009 – for the winter semester and whole academic year 1st October – mid February winter semester
31st December 2009 – for the summer semester
mid February – 30th June
summer semester
NOTE!! For students incoming to the Faculty of Biology and Environmental Protection applications deadlines are:
15th May 2009 – for the winter semester and whole academic year
15th October 2009 – for the summer semester
DANE OSOBOWE STUDENTA / STUDENT’S PERSONAL DATA
Nazwisko / Family name:...................................................................
Imię / First name ................................................................................
Płeć / Sex: ............... Narodowość / Nationality: .............................
Data urodzenia / Date of birth : .........................................................
Miejsce urodzenia / Place of birth: ....................................................
Adres / Address: ................................................................................
Telefon / Phone: ....................... E-mail:........................................
photograph
Czas studiów w Uniwersytecie Śląskim /
Period of studies at the University of Silesia: from .............................. to ..............................
(day, month, year)
(day, month,year)
Kierunek studiów w Uniwersytecie Śląskim/
Field of study at the University of Silesia: ................................................................................
Obecny rok studiów / Current year of studies : ..................................
Wezmę udział w tygodniowym kursie przygotowawczym/
I will take part in an orientation week :
YES
NO
UCZELNIA KIERUJĄCA / SENDING INSTITUTION
Nazwa uczelni / Name: ..............................................................................................................
Adres / Address: ........................................................................................................................
Koordynator wydziałowy / Departmental Coordinator:
(nazwisko i imię, telefon, fax, E-mail / name, phone, fax, E-mail)
....................................................................................................................................................
....................................................................................................................................................
Koordynator uczelniany / Institutional Coordinator:
(nazwisko i imię, telefon, fax, E-mail / name, phone, fax, E-mail)
....................................................................................................................................................
...................................................................................................................................................
ZNAJOMOŚĆ JĘZYKÓW / LANGUAGE COMPETENCE
Język ojczysty / Mother tongue: ................................................................................................
Znajomość języków / Knowledge of foreign languages:
początkujący /
beginner
średniozaawansowany /
intermediate
zaawansowany/
advanced
1.Polish (please state)
2............................
3. ..........................
4. ..........................
ZAKWATEROWANIE / ACCOMMODATION
Czy chcesz być zakwaterowany w domu studenta? /
Do you need a place in a University students’ hostel?
YES
NO
1. First choice .........................................................................................................................
2. Second choice ....................................................................................................................
single/double
address
price
Deklaruję, że zapoznałem/-łam się z Informatorem dla przyjeżdżających studentów i Regulaminem
zamieszkiwania w domach studenckich./
I declare that I got acquainted with Guide For Incoming Students and Regulation on accommodation
in the dormitories (available: http://erasmus.us.edu.pl)
..........................................................
Podpis studenta / Student’s signature
..........................................................
Miejscowość i data / Place and date
I recommend this student for studies at the University of Silesia within LLP/Erasmus
programme.
.................................................................................
Podpis koordynatora wydziałowego uczelni wysyłającej/
Sending institution Departmental Coordinator’s signature
..........................
Miejscowość i data /
Place and date
POTWIERDZENIE PRZYJĘCIA NA STUDIA W RAMACH PROGRAMU LLP/ERASMUS
WYPEŁNIA UNIWERSYTET ŚLĄSKI
ACCEPTANCE OF INCOMING STUDENT – ONLY FOR OFFICIAL USE AT THE UNIVERSITY OF SILESIA
.................
.................................................... .................
DATA
PIECZĘĆ I PODPIS DZIEKANA
DATA
....................................................
PODPIS KOORDYNATORA WYDZIAŁOWEGO
Please, fill in and return by post the completed original to:
University of Silesia
Department of International Relations and Projects
Bankowa 12, 40-007 Katowice, Poland
Phone/Fax: +48 32 359 11 78
E-mail: [email protected]
PLEASE, SEND ONLY COMPLETED FORMS. UNCOMPLETED DOCUMENTS WILL NOT BE ACCEPTED