Cracow Pedagogical University

PEDAGOGICAL UNIVERSITY

OF CRACOW

APPLICATION FORM

Life-long Learning - ERASMUS

INCOMING STUDENTS 2012/2013

HOME UNIVERSITY

STUDENT’S PERSONAL DATA

/please, write on computer/

Surname

First name(s)

Date of birth

DD/MM/YYYY ------/------/ ------PLACE OF BIRTH …......

SEX □ MALE □FEMALE

Father’s name Passport number

Nationality

HOME / CONTACT ADDRESS

Street/number City/ Post Code

Country

Telephone

/Country Code//Area Code//Number/

Mobile Phone

/Country Code//Number/

E-mail address1.                @                   

2.                 @                  

SENDING INSTITUTION DATA

Contact Person

E-mail address                @                 

International Relations Office Address

Street/number City/ Post Code

Tel Number fax Number

Institutional Coordinator’s Signature Stamp of the Home Institution or Erasmus Office

......

(The application will not be accepted without the above signature and stamp)

Verte!

STUDIES

Major field of your study Erasmus Subject Code (ISCED)

Number of years of study completed prior to your arrival to the University

Intended period of your stay at the University of Cracow: from 20…. .to20…...

LANGUAGE COMPETENCE

Language of studies at the Pedagogical University of Cracow : …......

I Listening Comprehension

a)Understands discussions and lectures without difficulty
b)Can follow lectures and normal conversation
c)Understands when speech is slow and distinct
d)Has difficulty understanding lectures and conversations
e) Unable to understand spoken language / □
□
□
□
□ /

III Written Formulation

a)Writes easily and correctly
b)Writes easily but with occasional errors
c)Writes slowly and with a number of errors
d)Writes with difficulty, makes basic errors
e)Unable to write even basic language correctly / □
□
□
□
□
II Oral Ability
a)Speaks fluently, correctly and with good pronunciation
b)Speaks fluently and clearly but with occasional errors
c)Speaks intelligibly, but not always correctly or fluently
d)Speaks hesitatingly and with numerous errors
e) Cannot communicate effectively / □
□
□
□
□ /

IV Reading Comprehension

a)Reads with ease and full comprehension
b)Reads with ease and general understanding
c)Reads slowly but grasps meaning of text
d)Has difficulty following text without dictionary
e)Cannot understand even simple texts / □
□
□
□
□

Mother tongue:

Other languages I am currently studyingI have sufficient knowledge

this languageto follow lectures

YESNOYES NO

………………..______

Comments:
Name of the language examiner: ...... Title: ………………………
Institution: ......
Place, date: ...... ….. Signature: ......
Stamp:

Verte!

ACCOMMODATION

The International Relations Office can book rooms for Erasmus students in the University Dormitory, situated within a walking distance from the University. The cost of accommodation in a double room per month/person is about 100 Euro. Expenses for utilities (electricity, water, and heating) are included in the price.

If you decide to stay at the “Academic Hotel Centre”, please be prepared to pay ( in Polish zloty PLN!! ) arepayable deposit equal to a two-month rate, i.e. 200 EUR. It will be given back to you only if your room is left in a good condition at your departure. You need to pay the deposit on the day of your arrival, before check-in.

Please bear in mind that the deadline for both semesters is June, 30.

If you want to have a room booked, please indicate: □ YES□ NO