STUDENT APPLICATION FORM

ACADEMIC YEAR /
FIELD OF STUDY:

SENDING INSTITUTION

Name of Sending Institution:
Full address of Sending Institution:
Country:
Departmental coordinator - name,
telephone and fax numbers,
e-mail box
Institutional coordinator - name,
telephone and fax numbers,
e-mail box

STUDENT'S PERSONAL DATA
(to be completed by the student applying)

Family name:
First name (s):
Sex:
Male Female
Date of birth (dd/mm/yyyy):
Wrong date format (dd/mm/yyyy)
Place of birth:
Nationality:
Current address: Street and number:
City:
Postal code:
Country:
Current address is valid until (dd/mm/yyyy):
Wrong date format (dd/mm/yyyy)
Permanent address (if different): Street and number:
City:
Postal code:
Country:
E-mail:
Wrong e-mail
Tel.:

INSTITUTION WHICH WILL RECEIVE THIS APPLICATION FORM

Institution Country Period of study
 Duration of stay (months) Numbers of expected ECTS credits
from
(dd/mm/yyyy)		 to
(dd/mm/yyyy)
University of Rzeszów
Poland
Wrong date format (dd/mm/yyyy)
Wrong date format (dd/mm/yyyy)
Do you want to apply for the accommodation?
yes no
From (dd/mm/yyyy)
Wrong date format (dd/mm/yyyy)
  To (dd/mm/yyyy)
Wrong date format (dd/mm/yyyy)
Briefly state the reasons why you wish to study abroad ?

LANGUAGE COMPETENCE

Mother tongue:
Language of instruction at home institution (if different):
Other languages I am currently studying this language I have sufficient knowledge to follow lectures I would have sufficient knowledge to follow lectures if I had some extra preparation
yes no
yes no
yes no
yes no
yes no
yes no
yes no
yes no
yes no

WORK EXPERIENCE RELATED TO CURRENT STUDY
(if relevant)

Type of work experience Firm/organisation Dates (dd/mm/yyyy) Country
Wrong date format (dd/mm/yyyy)
Wrong date format (dd/mm/yyyy)

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 ?

The attached Transcript of records includes full details of previous and current higher education study. Details not known at the time of application will be provided at a later stage.

Do you wish to apply for a mobility grant to assist towards
the additional costs of your study period abroad? 		yes no

ECTS - EUROPEAN CREDIT TRANSFER SYSTEM

DETAILS OF THE PROPOSED STUDY PROGRAMME ABROAD LEARNING AGREEMENT:

Course unit title (List of subjects taught in english
- http://www.univ.rzeszow.pl/eng/ects/wykaz_przedmiotow.doc)		 Number of ECTS credits

IMPORTANT REMARKS!

Send together with the application form:

Before coming to the University of Rzeszów, you need the following documents:

Students of nursing, midwifery and physiotherapy have to bring with themselves current results of examinations:

Students need also proper insurance for working in hospital

 

DEADLINE FOR APPLICATION:

Submit, print and send the Application Form duly signed, together with the documents required by ordinary post to:

University of Rzeszów
International Relations Office
ul. Rejtana 16C
35-959 Rzeszów
Poland