ECTS - PWSZ im. Witelona w Legnicy

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The Witelon University of Applied Sciences in Legnica - Introduction ACADEMIC YEAR: 20… /20…. FIELD OF STUDY: ......................................................... This application should be completed in BLACK in order to be easily copied and/or telefaxed. SENDING INSTITUTION ECTS Course Catalogue 2010/2011 (Photograph) Name and full address:........................................................................................................................................................ ............................................................................................................................................................................................. ............................................................................................................................................................................................. Department coordinator - name, telephone and fax numbers, e-mail ............................................................................... ............................................................................................................................................................................................. ............................................................................................................................................................................................. Institutional coordinator - name, telephone and fax numbers, e-mail ............................................................................... ............................................................................................................................................................................................. ............................................................................................................................................................................................. STUDENT’S PERSONAL DATA (to be completed in capitals by the student applying) Family name: ..................................................... Date of birth: ..................................................... Sex: ...................................................................... Nationality:......................................................... Place of Birth: .................................................... Current address: ................................................. ........................................................................... ........................................................................... ........................................................................... Current address is valid until: ............................. Tel.: ................................................................... E-mail: First name (s): ......................................................................... Permanent address (if different): ............................................ ................................................................................................. ................................................................................................. ................................................................................................. ................................................................................................. Tel.: ........................................................................................ LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM ( in order of preference): Institution Country Period of study Duration of stay N° of expected ECTS from to (months) credits .......................................... ......................................... The Witelon University of Applied Sciences in Legnica ECTS – EUROPEN CREDIT TRANSFER SYSTEM STUDENT APPLICATION FORM .................... ............. ........... .................. ................................... 20
The Witelon University of Applied Sciences in Legnica - Introduction Name of student: ................................................................................................................................................................. Sending institution: ………………………………………………………………………………………......................... Country: ……………………………………………………………………………………………………....................... Briefly state the reasons why you wish to study abroad ? .............................................................................................................................................................................................. .............................................................................................................................................................................................. .............................................................................................................................................................................................. …………………………………………………………………………………………………………….......................... LANGUAGE COMPETENCE Mother tongue: ................... Language of instruction at home institution (if different): .................................................... Other languages I am currently studying this language ............................. ............................ ............................ ECTS Course Catalogue 2010/2011 I have sufficient knowledge to follow lectures I would have sufficient knowledge to follow lectures if I had some extra preparation yes no yes no yes no WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant) Type of work experience ............................................ ............................................ PREVIOUS AND CURRENT STUDY Firm/organisation ............................................ ............................................ Dates ........................... ........................... Country ...................................... ...................................... Diploma/degree for which you are currently studying: .................................................................................. Number of higher education study years prior to departure abroad: .............................................................. Have you already been studying abroad ? Yes No If Yes, when ? at which institution ? ............................................................................................................. The attached Transcript of records includes full details of previous and current higher education study. Details not known at the time of application will provided be at a later stage. Do you wish to apply for a mobility grant to assist towards the additional costs of your study period abroad? Yes No RECEIVING INSTITUTION We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate’s Transcript of records. The above-mentioned student is Departmental coordinator’s signature ........................................................................... Date: ................................................................ provisionally accepted at our institution not accepted at our institution Institutional coordinator’s signature ...................................................................................... Date :............................................................................ 21
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ECTS - PWSZ im. Witelona w Legnicy

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