docstudent application form2 - Wyższa Szkoła Umiejętności Społecznych
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student application form2 - Wyższa Szkoła Umiejętności Społecznych
Wyższa Szkoła Umiejętności Społecznych w Poznaniu (Poznan School of Social Sciences) id: PL POZNAN17 Adres (Address): ul. Głogowska 26, 60-734 Poznań POLAND e-mail: [email protected] tel.: (+48 61)8862840 STUDENT APPLICATION FORM (Photography) ACADEMIC YEAR 20.../20... SEMESTER: WINTER SUMMER (please choose ONLY one semester) FIELD OF STUDY: .................................................................. This application should be completed in BLACK in order to be easily copied and/or faxed. SENDING INSTITUTION Name and address: ......................................................................................................................................................... .....................................................................................................................................................… ERASMUS ID Code of the institution: ………………………………….. Country…………………..…... Department coordinator - name, telephone numbers, e-mail, website: ......................................................................................................................................................... ......................................................................................................................................................... Institutional coordinator - name, telephone numbers, e-mail, website: ......................................................................................................................................................... ......................................................................................................................................................... STUDENT’S PERSONAL DATA (To be completed by the student applying) Family name: ....................................................… First name (s): .................................…................. Date of birth: ...................................................… Sex: ...........….. Nationality:.................................…..… Place of birth: ...................................................... Current address: ............................................................................................................................ ..........................................................................…......................................................................... ..........................................................................……..................................................................... Tel.: ..........................................................................……............................................................. Permanent address (if different):................................................................................................... ..........................................................................…......................................................................... ..........................................................................……..................................................................... Current address is valid until: ............................. Tel.: ................................................................….... e-mail:........................................................... 1 Wyższa Szkoła Umiejętności Społecznych w Poznaniu (Poznan School of Social Sciences) id: PL POZNAN17 Adres (Address): ul. Głogowska 26, 60-734 Poznań POLAND e-mail: [email protected] tel.: (+48 61)8862840 . Briefly state the reasons why you wish to study at our university? ............................................................................................................................................................ ............................................................................................................................................................ ............................................................................................................................................................ ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… LANGUAGE COMPETENCE Mother tongue: .............…... Language of instruction at home institution (if different): .......................... Other languages proficiency/ advanced intermediate C2* C1* B2* B1* basic A2* A1* *- levels in accordance with Common European Framework of Reference for Languages WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant) Type of work experience Firm/organisation Dates ............................................ .............................. ........................ ............................................ .............................. ........................ Country ........................ ........................ PREVIOUS AND CURRENT STUDY Diploma/Degree for which you are currently studying:..................................................................... Number of higher education study years prior to departure abroad: ................................................. Have you already been studying abroad? Yes No If Yes, when? At which institution? .................................................................................................. I attached Transcript of Records which includes full details of previous and current university study.Details not known at the time of application will be provided at later stage. Do you wish our university to help you to find the accommodation? Yes No Do you have any special needs: sight/ hearing disability, dyslexia, health problems that may require the provision of special facilities in your living or studying environment? Yes No Applicant’s signature ………………………… 2 Wyższa Szkoła Umiejętności Społecznych w Poznaniu (Poznan School of Social Sciences) id: PL POZNAN17 Adres (Address): ul. Głogowska 26, 60-734 Poznań POLAND e-mail: [email protected] tel.: (+48 61)8862840 CV: ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… Motivation letter: ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… Date:…………………. Applicant’s signature…………………………… 3 Wyższa Szkoła Umiejętności Społecznych w Poznaniu (Poznan School of Social Sciences) id: PL POZNAN17 Adres (Address): ul. Głogowska 26, 60-734 Poznań POLAND e-mail: [email protected] tel.: (+48 61)8862840 RECEIVING INSTITUTION We hereby acknowledge receipt of the Application, the proposed Learning Agreement and the candidate’s Transcript of Records. Accepted at our institution Not accepted at our institution Departmental Coordinator’s signature ___________________________________ Date___/___/___I Institutional Coordinator’s signature ___________________________________ Date___/___/___ 4
