UNIVERSITY OF D ORTMUND

Summer School 2004

Application
for financial aid

1) Personal Data

First Name: Last Name:

Academic Degree (if already finished):

Sex (please tick): female male Nationality:

Date of birth: Place of birth:

2) Mail addresses

Relevant address Home address

c/o
Street
Postal code/city
Country (incl. Postal letter)
Phone number
Email
3) Reasons for the application
Please state here the reasons why you want to apply for the scholarship

4) Amount of money requested

Please provide a detailed list of the different costs that you will encounter during the Summer
School and that should be covered by the scholarship.

Type of costs Amount

€
€
€
€
€
€
€

Total 0,00 €

Location Date Signature