Ects european credit transfer and accumulation system student application form

Data	07.05.2016
Rozmiar	42.7 Kb.

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):

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
Other languages	yes	no	yes	no	yes	no
1. English
2.
3.

WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)

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: