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APPLICATION FORM - MOBILITY FOR STUDIES
Thank you for your interest in realizing Student Mobility Exchange within Erasmus+ Programme at Powiślański University.
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* Indicates required question
1.
Study programme
*
Your answer
2.
Name
*
Your answer
3.
Surname
*
Your answer
4.
Email
*
Your answer
5.
Phone number
*
Your answer
6.
Place of birth (City, Country)
*
Your answer
7.
Date of birth
*
MM
/
DD
/
YYYY
8.
Sex
*
Male
Female
9.
Mother's full name
*
Your answer
10.
Father's full name
*
Your answer
11.
Nationality
*
Your answer
12.
Home address - country, city, postal code, street and home number (required if acceptance letter for visa application will be needed)
*
Your answer
13.
Do you have any special needs (physical, mental or medical disability, speech/language delays, cognitive delays etc.)?
Your answer
14.
Briefly state the reasons why you wish to study at PSW.
*
Your answer
15.
ID number or passport number (required if acceptance letter for visa application will be needed)
*
Your answer
16.
Mother tongue
*
Your answer
17.
English (Please indicate your level)
*
A1
A2
B1
B2
C1
C2
18.
Other language (Please indicate language and level)
*
Your answer
19.
Home university
*
Your answer
20.
Coordinator at home university - name, telephone and e-mail
*
Your answer
21.
Study cycle
*
EQF Level 6 (bachelor)
EQF Level 7 (master)
22.
Current study year
*
Your answer
23.
Have you already been studying abroad? If Yes, when, how long and at which institution?
*
Your answer
24.
Is there anything else we should know/you would like to share with us prior your mobility?
*
Your answer
25.
Will you be needing a laptop for the duration of your mobility?
*
yes
no
26.
Please state exactly which semester with the dates of your arrival.
*
Your answer
27.
I, as a student of the Erasmus + programme, agree to the processing of my image in the form of photos and videos on the University's social media for promotional purposes.
*
Agree
Disagree
28.
I declare that I have seen the course catalogue which is available on time and is entirely in English
*
yes
no
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