Dear Students Who Wish to Apply to Our Joint Certificate Programs in Lvivand Wroclaw For

Dear students who wish to apply to our Joint Certificate Programs in Lvivand Wroclaw for

“Advanced Computational Mathematics” organized jointly by
Ivan Franko National University of Lviv and Julius Maximilian University Würzburg .

“Selected Topics of Advanced Computer Science” organized jointly by
Lviv Polytechnic National University and Julius Maximilian University Würzburg .

“Selected Topics in Nanotechnology and Nanoscience” organized jointly by PolitechnikaWroclawska and Julius Maximilian University Würzburg

Welcome to the community of Julius Maximilian University Würzburg!

For admission please fill in this form with your computer!

Then send it without signature via email to the following address:

Please keep the original copy in your files! You will be asked to send the original copy with your signature and other documents via mail later.

* These fields must be filled (others only if applicable), thank you!

Personal Data

Family name*:

Given name(s)*:

Gender*:

Academic title:

Date of birth*:

Place of birth*:

Nationality*:

Home address

Street and house number*:

Addition (such as apartment number etc):

Country* :

Zipcode*:

Communication

Phone number, including country code for your country of residence :

Your e-mail address*:

Current and/or Previous education

Current University*:

Current Field of Study*:

Current year of study*:

Your current study is leading to which degree? (e.g. Bachelor, Master)*:

Have you obtained a diploma before in Germany*: Yes or no?

If yes, which diploma:

In which field:

At wich institution:

Date of obtaining the diploma*:

Secondary education* name of institution (high school):

City*:

Country*:

Type of institution*:

Date of diploma*:

Grade Point Average :

Have you previously obtained a bachelors degree?*:Yes or no?

If yes, in which field of studies*:

Name of institution*:

City* :

Country* :

Type of institution*:

Date of diploma* :

Grade Point Average:

Have you previously obtained a masters degree: Yes or no?

If yes, in which field of studies*:

Name of institution*:

City*:

Country* :

Type of institution*:

Date of diploma*:

Grade Point Average:

Simultaneous Education in Germany

Are you currently enrolled, or are you applying for another study in Germany for the same semester?*: Yes or no?

If yes, at which institution?

The course is leading to which degree? (e.g. Bachelor, Master)?

Which fields of studies?

Thank you for your interest in our Joint Certificate Program! We look forward to welcoming you in our classes!

For questions regarding admission and this form here please contactMrDieter THOMA:

Your Signature: ______Date: ______