VINCENT POL UNIVERSITY in Lublin
Wyższa Szkoła Społeczno – Przyrodnicza
im. Wincentego Pola w Lublinie, Poland
APPLICATION FORM FOR
INCOMING ERASMUS STUDENTS (SMS) 2017/18
Note! Please use only CAPITAL letters (if handwritten) or fill in the electronic form.
PERSONAL DATA
Family name(-s)
First name(-s)
Date of birth
Photo
Place of birth
Nationality
Father’s first name
Mother’s first name
Gender*
Male
Female
Address (please fill in below):
Street, no
Postal code
Town
Country
Telephone number
(with Area code)
E-mail address
ID or passport number
HOME INSTITUTION
Name
Address
Erasmus code
Faculty / Department
Field of study
Level of study*
Year of study (currently)
Erasmus Coordinator
(name, phone and e-mail)
BA
MA
STUDY PERIOD *
1st semester
2nd semester
Whole academic year
LANGUAGE COMPETENCE
Mother tongue
Other languages:
(Please choose your level:
A1 – beginner,
A2 – elementary,
B1 – intermediate,
B2 – upper-intermediate,
C1 – advanced,
C2 – proficiency.)
……………………..
……………………..
………..……………
……………………..
……………………..
……………………..
……………………...
A1, A2, B1, B2, C1, C2
A1, A2, B1, B2, C1, C2
A1, A2, B1, B2, C1, C2
A1, A2, B1, B2, C1, C2
A1, A2, B1, B2, C1, C2
A1, A2, B1, B2, C1, C2
A1, A2, B1, B2, C1, C2
Do you plan to attend the Polish language course for foreign students? * (recommended)
YES
NO
ADDITIONAL INFORMATION
Special needs or requests?
(if needed)
EMERGENCY CONTACT DETAILS
First Name(s): …………………………………………………
Family Name: …………………………………………………
Telephone No: ………………………………………………..
Relationship: …………………………………………………
…………………………………
Place and date
……………………………………
Student’s signature