univerzita palackého v olomouci

LLP

ERASMUS PROGRAMME

Photograph

ACCOMMODATION REQUEST FORM

ACADEMIC YEAR …………….

Please fill in the form and return to: / International Liaison Office
By June 15 for fall semester / Palacký University
By November 15 for spring semester / Krízkovského 8
771 47 Olomouc
(fax copies are accepted, please mail / Czech Republic
the form as well) / Tel: +420-58-563 1108
Fax: +420-58-522 3494

Please enclose TWO additional passport size photographs with your application.

Last name:
First name:
Gender:
Date of birth:
Passport number:
Permanent address:
E-mail address:
Telephone number:
Person to contact in case of emergency:
Name and relation:
Address (if different from above), including telephone number:
Home institution:
Study at Palacky University:
Faculty:
Department: / Semester (please mark):
Fall semester Spring semester
Arrival: / Departure:

Accommodation required : yes no
If yes , the International Liaison Office will on your behalf book an accommodation in
Palacky University Accommodation Facility located on Neredin campus*
(mailing) address:
Neredin Hall of Residence / VSK Neredin
Tr. Miru 113 – recepce
772 00 Olomouc
Name(s) of any student(s) with whom you would like to share a room:
Please note: Smoking is not allowed in any of Palacky University Halls of Residence

*Description of accommodation

NeředínSuites of four rooms - two single and two double. A bathroom for every two rooms . In every suite you find telephone, kitchen area with stove and refrigerator .

Neředín campus, 15 min by tram to the University.

Please note that starting the academic year 2009-2010 all students will

be asked to pay a refundable deposit of 2500,- CZK ( approximately 100 Euro )

upon their arrival and registration in students´ hall of residence.

Also please note that the date of your arrival is obligatory. You will be charged for housing from the date you state in your application form. Should you make any changes regarding your arrival date, after sending the application form, please inform the International Liaison Office as soon as possible at