/ Application form
for student’s participation
in EuCerMat project /

Section 1. Personal data.

1 / Name and surname
2 / E-mail address
3 / Phone number
4 / Address for correspondence
5 / Field of study / Ceramics / Chemical Technology / Materials Engineering
6 / Speciality of study
7 / Average (weighted ECTS points) of grades gained during first level of study, / My average grade at first level of study is ....
8 / Average (weighted ECTS) of grades gained during second level of study. / My average grade at second level of study is ....

Section 2. Declaration of participation in EuCerMat project.

1 / I declare my will to participate in EuCerMat project / Yes, I do No, I don’t
2 / I will prepare my motivation letter for industrial partners of EuCerMat project till October 3rd, 2016. / Yes, I will No, I won’t
3 / I will take part in “Integration Week” in October 3rd-7th, 2016 in Limoges, France. / Yes, I will No, I won’t
4 / I will take part in at least one e-learning classes (5 ECTS credits) in October 2016 – February 2017. / Yes, I will No, I won’t
5 / I will take part in internship at an industrial partner of the EuCerMat project – March-August 2017. / Yes, I will No, I won’t

Section 3. Statements

1 / I declare that I am second year student of full-time master level studies at the Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow. / Yes, I do No, I don’t
2 / I declare that I passed English language course at level B2 or better/higher. / Yes, I do No, I don’t
3 / I understand that some industrial partners of the project don’t offer a scholarship for internship. I understand that I am able to apply for scholarship from Erasmus+ programme at my university. / Yes, I do No, I don’t
4 / I understand that not all my expenses/costs of participation in the project will be financed by EuCerMat partners. I accept partial self-financing. / Yes, I do No, I don’t
5 / I accept that all correspondence will be sent by e-mail and phone (sms). / Yes, I do No, I don’t
6 / Wyrażam zgodę na przetwarzanie moich danych osobowych zawartych w niniejszym formularzu aplikacyjnym dla potrzeb niezbędnych do realizacji procesu rekrutacji do projektu EuCerMat oraz uczestnictwa w tym projekcie, zgodnie z ustawą z dnia 29 sierpnia 1997 roku o ochronie danych osobowych (tekst jedn.: Dz. U. z 2016 r. poz. 922). / Tak, wyrażam zgodę
Nie, nie wyrażam zgody

Please send the complete application in PDF till (end of the day on) Thursday, September 15th, 2016 to:
Bartosz Ostrowski, or print it and sign it and bring it to the office for students’ affairs.

If You have any questions, please contact: Bartosz Ostrowski, , phone no: 12617 23 34.