Application Form for Incoming Students

UNIWERSYTET OPOLSKI

Program/Agreement …………………………………………………………….

………………………………………………………………………………………… Application Form for Incoming Students

(This application should be completed with CAPITAL and BLACK letters in order to be easily copied and/or telefaxed)

Academic year ………………………..

First name ………………………………………………………………..

Family name ……………………………………………………………..

Sex: M F

Nationality ………………………………………………………….……..

Citizenship ……………………………………………………………….

Date and Place of birth ………………………………………………….

Parents’ first names: mother ………………………..…… father………………………..………...…

Permanent address ………………………………………………………………………………..………..

………………………………………………………….……..………………………………………….……

Address for correspondence …………………………………………………………………………….…

……………………………………………………………………………………………….………...………Telephone ………………………………………………………………..

Fax ……………………………………………………………………….

E-mail address ………………………………………………….………

ID number ………………………………………………………………..

Home University ……………………………………………………………………….……………….……

Department ……………………………………………………………………….…………...……….…

Year / semester ……………………………………………………………………….…………….….……

Intended period of stay at Uniwersytet Opolski ………………………………………months from ………… / ………… / ………… till ………… / ………… / …………

(day/month/year) (day/month/year)

Department……………………………………………………………

Language competence: mother language ……………………………………………………….

Other languages / Fluent / Good command / Poor command

Accommodation: required from .……./ ……. /……. till ……. /……./……..

(students' hall of residence) not required

Student’s signature ………………………………………….…….……………………………………….

President’s/Dean’s signature …………………………………………………………………………….
To the application must be added:

1.  list of scientific achievements of the past three years,

2.  proof of English proficiency language (language certificate or other document of English language skills),

3.  information on the average grade of all existing studies,

4.  opinion of the academic tutor,

5.  copy of passport,

6.  copy of health insurance,

7.  2 actual photos,

Uniwersytet Opolski Program/Agreement……………………………………………………………………………………………………………………………………………………………….

Application for Accommodation

Opole University can offer a limited number of places for international students in dormitories (www.campus.uni.opole.pl).There are only double and triple rooms (no single rooms!). The complete application form must be returned to:

Opole University

Biuro ds. Badań Naukowych i Współpracy z Zagranicą

Pl. Kopernika 11a

45-040 Opole, Poland

Fax.: +48/ (0) 77 54 15 969

e-mail:

PLEASE PRINT ALL DATA BELOW IN CAPITAL LETTERS

1.  Family name

2.  First name(s) 3. Sex (F/M)

4. ID Number

Home University and field of studies: ______

Correspondence address:

5. Postal code 6. City

7. Street 8. Number

9. Country

10. Phone No.

11. E-mail address

Period of stay:

from (______/______/______) to (______/______/______)

Arrival date: ______

Date Student's signature