2018-2019 Wroclaw University exchange program

Name: ______

Citizenship: ______

APPLICATION

Please read carefully all instructions BEFORE filling out this application!!!

  • Please answer ALL questions of the application in ENGLISH or Polish where allowed (questions 14,15,16)
  • Write your full name and country of citizenship in the top right corner of each page.
  • Include your full legal name. Write your family name (surname) first, exactly as it is spelled on your international passport (if available). Do not translate name spellings (for example, write Mariya and not Mary).
  • Include complete contact information (including index codes for your address and codes for all phone numbers). Do not translate street or city names into English, only into the English alphabet (for example, write Prospekt Mira instead of Peace Avenue).
  • DO NOT leave a space blank. If a question does not apply to you, enter N/A (not applicable).
  • Handwritten applications must be neatly printed in black ink. All statements of purpose must be typewritten.
  • This application when completed can be returned via email to . To avoid casual changes please convert the filled out application into PDF before sending. You can save this application in PDF using “Open Office”.
  • INCOMPLETE applications will be disregarded.
  • This application consists of SEVEN pages and must NOT contain more pages after filling it out.

1. Name (as in official documents): ______

(Family Name)(First Name)(Middle Name or Patronymic)

2. Citizenship: ______

3. Place of Birth: ______

(City or Town)(Country)

4.Date of Birth:______

(Day) (Month)(Year)

5.Gender: Male  Female

6. Passport (travel document) number: ______

Valid until: ______

(Day) (Month)(Year)

7. Current Address (registration):

Street / building number: Apartment:

City: Postal Index:

Mobile Telephone: ( )______Email: ______

Alternate telephone: ( )______

8. Faculty / Department:______

Group:______Year of Study;______

9.Proposed Semester of programme (Please check one semester you want to be considered for. NOTE: approximately half of all finalists will be placed in the 1st semester and half for the 2nd. You may be placed in any semester even in you do not specifically check off this option, or check the other semester.

First Semester Second Semester Does NOT Matter

10.Are you currently applying to any other sponsored educational programmes for the next academic year?

 Yes No

If yes, please specify which programme:______

Name of Sponsoring Organization: ______

11.Have you previously traveled on AN EXCHANGE programme?  Yes No

IF YES, PLEASE LIST PROGRAMME NAME, DATES AND LOCATION:

12. Beginning with English followed by Polish, list all languages you know and rate your reading, writing, listening, and speaking skills in each language, using Excellent, Good, Fair, and Poor.

Language / Reading / Writing / Listening / Speaking
English
Polish

13. Polish Language courses at TSPU attended from:______

(Day) (Month) (Year)

14. List below in English or Russian ALL university courses you have taken at TSPU and the grades you received. (List in chronological order. Attach additional lines if necessary. Be ready to present your record book for verification when submitting this application)

Applications are free of charge and may be duplicated.

Формы заявки являются бесплатными и могут копироваться

Application deadline: 16:00, April 20th 2018

2018-2019 Wroclaw University exchange program

Name: ______

Citizenship: ______

ACADEMIC YEAR
(for example 1990-1995) / SUBJECT / COURSE
(class title) / GRADE

Applications are free of charge and may be duplicated.

Формы заявки являются бесплатными и могут копироваться

Application deadline: 16:00, April 20th 2018

2018-2019 Wroclaw University exchange program

Name: ______

Citizenship: ______

15. Statement of Purpose (maybe written in English or Russian): In one, typewritten page, please write an essay describing your future career plans, why you want and need to study at Wroclaw University and how you hope to contribute to TSPU upon your return. Please choose a clear, easily readable, professional font—such as Times New Roman 12 pt. or Arial 10 pt.

16.Program of Study Essay (maybe written in English or Russian): In one typewritten page, please write a detailed essay describing your intended program of study in Wroclaw, including specific areas of interest, potential coursework, and/or research topics. You are strongly encouraged to check the website of Wroclaw University. Please choose a clear, easily readable, professional font—such as Times New Roman 12 pt. or Arial 10 pt.

17.Resume or Curriculum Vitae (C.V.): Attach a copy of your current resume or Curriculum Vitae (C.V.) This should not exceed one page. A sample resume is included on the next page to assist applicants.

(This is a Sample Resume Only—Please Do Not Include Sample in Submitted Application)

Natalia Nikolaevna Ivanova

1025 Ul. Tsentralnaya, Apt. 200

Ekaterinburg, 620083

Russia

(367) 22-65-98

PROFESSIONAL EXPERIENCE

Uralskiy Vestnik – Ekaterinburg, Russia

Journalist (10/2002-present)

Conduct interviews of leading business persons

Report on regional politics and business development

Act as member of weekly editorial team

Center for Journalism in Extreme Situations – Ekaterinburg, Russia

Program Manager (01/2000-present)

Assist Ural regional expert with research and client case management

Draft weekly reports to international funding groups

Develop and oversee center budget

British Council Small Grant Program Recipient

Conference Organizer (01/2003-12/2003)

Developed and managed a conference on independent media resources and the Internet for journalists and journalism students at Ural State University

Drafted concept paper for funding of conference

US Peace Corps – Ekaterinburg, Russia

Business Education and Community Development /BECD Project Manager (10/1999-9/2002)

Assessed business education needs at Institutions of Higher Education

Developed and implemented project plans to address these needs within the Peace Corps mission

EDUCATION

Ural State University – Ekaterinburg, Russia

diplom (09/1994-07/1999)

Department of Journalism

PROFESSIONAL DEVELOPMENT

Best Student Journalist, Uralskiy Vestnik and Ural Business Forum Sponsored Competition

Winner for Marketing Optimism and Entrepreneurial Spirit in the Urals, published August 1999

Journalists and the Internet Workshop – Moscow, Russia 1998

Participant in workshop on internet resources and online ethics for students of journalism

Teacher of Journalism, Advisor for Student Newspaper – Ekaterinburg, Russia

Volunteer at alma mater, School Number 5, 1994-1998

COMPUTER SKILLS

Microsoft Word, Explorer, Excel, PowerPoint, Outlook, Adobe PhotoShop, PageMaker

LANGUAGES

Russian (fluent), English (excellent), French (basic)

Privacy Policy Statement and Application Certification

Я согласен, что информация, предоставленная мною, может быть передана в принимающий университет.

Я подтверждаю, что я заполнил данное заявление самостоятельно, без чьей либо помощи. Информация в данном заявлении является полной и точной.

Мне известно, что Международный информационный центр ТГПУ оставляет за собой право проверить информацию, предоставленную мной в данной заявке. Мне известно, что предоставление ложных сведений и информации влечёт исключение моей заявки из конкурсного отбора и дальнейшего участия в программе обмена.

Мне известно, что я несу ответственность за своевременное получение заграничного паспорта и в случае его отсутствия в нужный срок, моя кандидатура будет снята автоматически.

Мне известно, что окончательное решение о моём участие в программе обмена зависит от согласия Вроцлавского Университета и моей способности получить Польскую/Шенгенскую визу.

Я заявляю, что я внимательно прочитал и понял выше перечисленные заявления в полном объёме.

Подпись / Signature of applicantЧисло / Date

When returning this application via email you must print out the last page, put the date and sign it.

Do not forget to bring this page to the International Office and make sure your application has arrived.

International Information Office

pr. Komsomolsky 75, ULK-213

Tomsk

Email:

Tel. +7 (3822) 311396

Fax: +7 (3822) 522066

Applications are free of charge and may be duplicated.

Формы заявки являются бесплатными и могут копироваться

Application deadline: 16:00, April 20th 2018