Erasmus Student Application

Jagiellonian University PL_KRAKOW01

For
Academic year: 200 /200

Full Academic Year: Winter Term: Summer Term:

Please USE CAPITAL LETTERS and return completed form to:

International Students Office, Jagiellonian University, Gołębia 24, PL 31-007 Kraków

Completed application form for full academic year and winter term should be returned no later than
June 15 and for the summer term no later than November 30.

Information about studies

Home university:

Institution Code:

Programme coordinator at home university (name and email):

Field of Studies:

Area Code:

Personal data

Surname:

First name(s): Sex: m/f

Date of birth: Place of birth:

Citizenship: Nationality:

Polish descent: (yes/no) Mother language(s)

Current address: Street: Number:

Postal code: City: Country:

Permanent (home) address if different:

ID or PASSPORT number: Type of document: ID / PASSPORT

E-mail @

Person to be notified in case of emergency (phone)

I hereby certify that the information given on this form is correct

Date Signature

_______________________________
Date
_______________________________
Faculty Coordinator's Signature Stamp