TECHNICKÁ UNIVERZITA V KOŠICIACH
                    TECHNICAL UNIVERSITY OF KOŚICE

STUDENT APPLICATION FORM
										  
                                                                                                	(Photograph)
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
Name and full address: .................................................................................................................................
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Department coordinator - name, telephone and telefax numbers, e-mail box ...................................................
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Institutional coordinator - name, telephone and telefax numbers, e-mail box .....Ing. Erna Béres tel.: +421 55 602 2114, fax: +421 55 602 2108: erna.beres@tuke.sk......................	
STUDENT’S PERSONAL DATA
(to be completed by the student applying)
Family name: .....................................................
Date of birth: .....................................................
Sex: ..............Nationality:...................................
Place of Birth: ....................................................
Current address: .................................................
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Current address is valid until: .............................
Tel.: ...................................................................
E-mail:…………………………………………
	First name (s): ...............................................................

Permanent address (if different): ....................................
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Tel.: .............................................................................  	
LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of preference):
Institution
	Country	Period of study
from          to	Duration of stay (months)	N° of expected ECTS credits	
1. ......................................
2. ......................................
3. ......................................	....................
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Name of student: ..........................................................................................................................................
Sending institution:
............................................................................................. Country: .........................................................

Briefly state the reasons why you wish to study abroad ?
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LANGUAGE COMPETENCE

Mother tongue: ................... Language of instruction at home institution (if different): ..................................	
Other languages	I am currently studying this language	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	
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WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)

Type of work experience

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............................................	Firm/organisation

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...........................................	Dates

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...........................	Country

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PREVIOUS AND CURRENT STUDY

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

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Date: .................................................................	provisionally accepted at our institution
not accepted at our institution

Institutional coordinator’s signature

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Date :.............................................................................