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Application Form

This document is an application form for the University of Economics and Innovation in Lublin, Poland for the 2020/2021 academic year. It requests personal information such as name, date of birth, address, parents' names, nationality, and contact details. It also asks for information on the applicant's secondary education such as the name of the school and dates attended as well as their English language proficiency. Other sections inquire about the applicant's field and degree of study being applied for, accommodation preferences, disability information if applicable, and documents required to be submitted with the signed application form.

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Tasimba
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101 views3 pages

Application Form

This document is an application form for the University of Economics and Innovation in Lublin, Poland for the 2020/2021 academic year. It requests personal information such as name, date of birth, address, parents' names, nationality, and contact details. It also asks for information on the applicant's secondary education such as the name of the school and dates attended as well as their English language proficiency. Other sections inquire about the applicant's field and degree of study being applied for, accommodation preferences, disability information if applicable, and documents required to be submitted with the signed application form.

Uploaded by

Tasimba
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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APPLICATION FORM

FOR THE ACADEMIC YEAR 2020/2021

I would like to apply for the following studies


at University of Economics and Innovation in Lublin, Poland
Select one field of study
Field of study Degree of study Field of study Degree of study
COMPUTER SCIENCE Bachelor Degree (BA) ECONOMICS Master Degree (MA)

MANAGEMENT Bachelor Degree (BA) MANAGEMENT Master Degree (MA)

LOGISTICS Bachelor Degree (BA) COMPUTER SCIENCE Master Degree (MA)

NURSING Bachelor Degree (BA)

PERSONAL DATA – fill in capital letters


Name Surname

Middle name Gender


MALE FEMALE

Date of birth – day / month / year Place of birth

Parents name and surname


Name Surname Name Surname
Father Mother

ID / Passport number Nationality Country of permanent residence

Visa number Residence card number

PERMANENT ADDRESS
Postcode Street Home / flat number

City / town Village Country

PLACE OF RESIDENCE
Cities Towns and suburbs Rural areas
Densely populated areas Intermediate density areas Thinly populated areas
Telephone number E-mail address

CORRESPONDANCE ADDRESS – fill in if different then above


Postcode Street Home / flat number

City / town Village Country


APPLICATION FORM
FOR THE ACADEMIC YEAR 2020/2021

SECONDARY SCHOOL, COLLEGE / UNIVERSITY OF CANDIDATE DATA


SECONDARY SCHOOL
Attended school Town / City Country

Type of received certificate No. of certificate

Dates of attended school Country


Beginning End
COLLEGE / UNIVERSITY
Attended college / university Town / city Country

Type of received certificate Number of Diploma

Dates of attended college / university Year of graduation


Beginning End
Type of awarded degree
Bachelor degree Master degree None
College / University programmes / courses

ENGLISH LANGUAGE KNOWLEDGE


English language certificates
Name of examination
Grade / score Date of examination

Level of knowledge
Elementary Intermediate Advanced Proficiency
Reading

Writing

Speaking
APPLICATION FORM
FOR THE ACADEMIC YEAR 2020/2021

OTHER DATA
IN CASE OF EMERGENCY PLEASE CONTACT
Name Surname Relationship

Address Telephone number E-mail

WOULD YOU LIKE TO APPLY FOR ACCOMMODATION ?


No Single room Double room Triple room Apartment
SOURCE OF INCOME
Own business activity Own job Farm Allowances

Parents job Pension Other


WORKPLACE
Employer's name

Address
DISABILITY
DEGREE OF DISABILITY

TYPE OF DISABILITY

I agree to the processing of my personal data included in the application for recruitment, according to the Act of 29 August 1997
on Personal Data Protection, DZ. U. Nr 101, poz. 926 as amended. I declare that the statements made by me on this form are to
the best of my knowledge and belief, true and correct. If my application is accepted I will follow the university’s regulations and
ensure payment of fees and other liabilities.

……………………………………………………..................................
(Date and Signature of the candidate)

Enclosed documents (scanned and send with signed Offer Letter by e-mail: [email protected])
1. A certificate or another equivalent document (legalized or provided with apostille) confirming that the applicant is eligible for admission
to higher education in the country in which he or she completed secondary school. The certificate will require nostrification by the Local
Polish Education Authority. A mentioned certificate must be accompanied by a sworn translation.
2. A medical certificate confirming that there are no contraindications to study on the chosen field of studies
3. A copy of ID or passport.
4.Two Current photographs (35mm x 45mm, at least one colour photograph).
5. Copy of passport, visa and/or residence card (if issued).
6. Certificate of English Language Proficiency
7. Copy of insurance policy (accident insurance or health insurance).

……………………………………………………..................................
(Date and Signature of the candidate)

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