LLP - ERASMUS STUDENT MOBILITY

INCOMING STUDENT APPLICATION

2013 / 2014

FOR ACADEMIC YEAR

winter semester

summer semester

This application should be completed in clear block capital letters and returned
before 15th June for the winter semester or full academic year,
before 15thDecember - for summer semester
to the address:
Faculty of Electronics and Information Technology
Warsaw University of Technology
ul. Nowowiejska 15/19
00-665 Warszawa, POLAND

STUDENTS PERSONAL DATA

Family name:

First name (s):

Date of birth:

Place of Birth:

Sex:

Current address:

Nationality:

Permanent address (if different):

Tel.:
Current address is valid until:

E-mail:

PREVIOUS AND CURRENT STUDY

Grade Point Average (cumulative):

Index number:

Field of study:

Diploma/degree for which you are currently studying:

Have you already been studying abroad ?

Current semester of study:

Yes

If Yes, when ? at which institution ? what programme ?

No

LANGUAGE COMPETENCE
Mother tongue:

Other languages

Language of instruction at home institution (if different):

I am currently studying this
language
yes

no

I have sufficient knowledge to

follow lectures
yes

no

I would have sufficient

knowledge to follow lectures if I
had some extra preparation
yes

no

WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)

Type of work experience

Firm/organisation

Dates

Country

Briefly state the reasons why you wish to study abroad ?

Name of student:

Date:

Signature:

Signature:

Tutors recommendation (optional):

Tutors name:

Date:

LLP - ERASMUS STUDENT MOBILITY