Ects european credit transfer and accumulation system student application form



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THE STATE COLLEGE OF COMPUTER SCIENCE AND BUSINESS ADMINISTRATION


IN ŁOMŻA




ECTS – EUROPEAN CREDIT TRANSFER AND ACCUMULATION SYSTEM
STUDENT APPLICATION FORM


(Photograph)











ACADEMIC YEAR 20   / 20  
FIELD OF STUDY:      
This application should be completed in BLACK in order to be easily copied, faxed or e-mailed.


SENDING INSTITUTION

Name and full address: The State College of Computer Science and Business Administration in Łomża, Akademicka 14, 18-400 Łomża, Poland


Department coordinator – name, telephone, fax and e-mail

     
Institutional Coordinator – name, telephone, fax and e-mail

mgr Lilianna Rywacka, tel:086- 215-66-08, fax:086-215-66-08,

e-mail: lrywacka@pwsip.edu.pl





STUDENT’S PERSONAL DATA

(to be completed by the student applying)


Surname:      

Date of birth:    /  /     

Sex: 

Nationality: Polish



Place of birth:      

Current address:

     

     


Poland

Address valid until:    /  /     

Tel: +48 

Fax: +48 

E-mail:      


First Name:      

Permanent address (if different):

     

     


     
Tel:      

Fax:      

E-mail:      

LIST OF INSTITUTIONS WHICH WILL RECEIVE THIS APPLICATION FORM (in order of student preference):




Institution

Country

Period of study

length of Stay

(months)


No. of ECTS credits expected

From

To

1. 



   /  /   

   /  /   

  

    

2. 



   /  /   

   /  /   

  

    

3. 



   /  /   

   /  /   

  

    




Name of Student:      

Sending institution: The State College of Computer Science and Business Administration in Łomża

Country: Poland





Briefly state the reasons why you wish to study abroad.

     




LANGUAGE COMPETENCE


Mother tongue: Polish

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

1. English













2.      













3.      













WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)




Type of work experience

Company / Organisation

From

To

Country

1.      

     

   /  /   

   /  /   

     

2.      

     

   /  /   

   /  /   

     

3.      

     

   /  /   

   /  /   

     


PREVIOUS AND CURRENT STUDY


Diploma / Degree for which you are currently studying: Bachelor's Degree

Number of study years at higher education level prior to departure:  




Have you already studied abroad?


Yes 

No 

If yes, at which institution?


     

When?

From

To

   /  /   

   /  /   


The attached transcript of records includes full details of previous and current higher education study. Details not known at the time of application will be provided 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 named student is:


 Provisionally accepted at our institution


 Not accepted at our institution


Departmental coordinator’s signature
……………………………………………….

Date:


Institutional coordinator’s signature
………………………………………………..

Date:



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Pobieranie 42.7 Kb.





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