PEDAGOGICAL UNIVERSITY
OF CRACOW
(photo)
APPLICATION FORM
Life-long Learning - ERASMUS
INCOMING STUDENTS 2012/2013
HOME UNIVERSITY
STUDENT’S PERSONAL DATA
/PLEASE, WRITE ON COMPUTER/
SURNAME
FIRST NAME(S)
DATE OF BIRTH
DD/MM/YYYY
---- ---- /---- ---- / ---- ---- ---- ---□ MALE
SEX
PLACE OF BIRTH
….................................................................................
□ FEMALE
FATHER’S NAME
PASSPORT NUMBER
NATIONALITY
HOME / CONTACT ADDRESS
STREET/NUMBER
CITY/ POST CODE
COUNTRY
TELEPHONE
/COUNTRY CODE /
/AREA CODE/
/COUNTRY CODE /
/NUMBER/
/NUMBER/
MOBILE PHONE
E-MAIL ADDRESS 1.
                @                   
2.                 @                   
SENDING INSTITUTION DATA
CONTACT PERSON
E-MAIL ADDRESS
               @                
INTERNATIONAL RELATIONS OFFICE ADDRESS
STREET/NUMBER
CITY/ POST CODE
TEL NUMBER
FAX NUMBER
INSTITUTIONAL COORDINATOR’S SIGNATURE
STAMP OF THE HOME INSTITUTION OR ERASMUS OFFICE
........................................................................
.....................................................................................
(The application will not be accepted without the above signature and stamp)
1
Verte!
STUDIES
Major field of your study
Erasmus Subject Code (ISCED)
Number of years of study completed prior to your arrival to the University
Intended period of your stay at the University of Cracow: from
20…. .to
20…...
LANGUAGE COMPETENCE
Language of studies at the Pedagogical University of Cracow :
I Listening Comprehension
a) Understands discussions and lectures
without difficulty
b) Can follow lectures and normal
conversation
c) Understands when speech is slow
and distinct
d) Has difficulty understanding
lectures and conversations
e) Unable to understand spoken language
III Written Formulation
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II Oral Ability
………………..
………………..
………………..
a) Writes easily and correctly
b) Writes easily but with occasional
errors
c) Writes slowly and with a number of
errors
d) Writes with difficulty, makes basic
errors
e) Unable to write even basic
language correctly
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□
□
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□
IV Reading Comprehension
a) Speaks fluently, correctly and with
good pronunciation
b) Speaks fluently and clearly but with
occasional errors
c) Speaks intelligibly, but not always
correctly or fluently
d) Speaks hesitatingly and with
numerous errors
e) Cannot communicate effectively
Mother tongue:
Other languages
…...........................................
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a) Reads with ease and full
comprehension
b) Reads with ease and general
understanding
c) Reads slowly but grasps meaning of
text
d) Has difficulty following text
without dictionary
e) Cannot understand even simple
texts
I am currently studying
this language
YES NO
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I have sufficient knowledge
to follow lectures
YES
NO
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Comments:
Name of the language examiner: ....................................................... Title: ………………………
Institution: .........................................................................................................................................
Place, date: ...................................................….. Signature: ...........................................................
Stamp:
2
Verte!
ACCOMMODATION
The International Relations Office can book rooms for Erasmus students in the University
Dormitory, situated within a walking distance from the University. The cost of accommodation
in a double room per month/person is about 100 Euro. Expenses for utilities (electricity, water,
and heating) are included in the price.
If you decide to stay at the “Academic Hotel Centre”, please be prepared to pay ( in Polish zloty
PLN!! ) a repayable deposit equal to a two-month rate, i.e. 200 EUR. It will be given back to you
only if your room is left in a good condition at your departure. You need to pay the deposit on
the day of your arrival, before check-in.
Please bear in mind that the deadline for both semesters is June, 30.
If you want to have a room booked, please indicate:
□ YES
□ NO
........................................................
date and signature
3
STUDENT’S PERSONAL DATA
/PLEASE, WRITE ON COMPUTER/
SURNAME
FIRST NAME(S)
DATE OF BIRTH
DD/MM/YYYY
SEX
FATHER’S NAME
––/–– /–––––
□ MALE
□ FEMALE
PASSPORT NUMBER
NATIONALITY
4