For office use only

(Gauta) (Reg. Nr.)

MYKOLO ROMERIO UNIVERSITETAS

MYKOLASROMERISUNIVERSITY

NON-DEGREE STUDIES APPLICATION FORM

Academic year 20…./20….

Please print or type, or write in capital letters in BLACK and fill out

COMPLETELY and ADD ALL REQUIRED ENCLOSURES (Photograph)

in order to be processed

I. APPLICANT’S PERSONAL DATA

Family name: First name (s):

Date of birth: //Place and country of birth:

(day, month, year)

Sex: Marital Status:Nationality:

(F/M)Single/Married

Current postal address:

Current address is valid until: / /

Country(Please notify us of any changes)

()()

Telephone (incl.area code) Telefax (incl.area code)E-mail

Person(s) and telephone number to contact in case of emergency:

I.

Name, relationship to the applicantTelephone (incl.area code)

Passport data:

Country of Citizenship

Passport/ID card NumberIssued at

Place Date

Valid till//

(day, month, year)

II. EDUCATIONAL BACKGROUND

List all institutions you have ever attended (in a chronological order). Include Undergraduate and Graduate schools, Universities, Colleges and indicate any degree or diploma you have ever earned or expect to receive. (Students must also submit transcripts of all their University degrees and diplomas):

Institution & LocationDates of attendance Field of studyDegree, certificate

from/to(if relevant)or Diploma

III. LANGUAGE COMPETENCE

Mother tongue:

Language(s) of instructions at previous institutions (if different)

Other languages / Speaking / Reading / Writing
Excellent / Good / Fair / Excellent / Good / Fair / Excellent / Good / Fair
. .
. .
. . / 

 / 

 / 

 / 

 / 

 / 

 / 

 / 

 / 


IV. DURATION OF STUDY PERIOD

Autumn Semester 

Spring Semester 

Academic Year 

I will participate in Introductory Week (one week before the Semester) Yes 

No 

V. CURRICULUM PROPOSAL

Please check the list of courses available at: .

Semester
(Autumn/ Spring) / Course title / ECTS credits

VI. FINANCES

How do you intend to fund your studies at MykolasRomerisUniversity?

MykolasRomerisUniversity charges tuition fees (unless you receive tuition waiver). For academic year 2013-2014 tuition fee for 1 ECTS credit for EU citizensis from 19 Eur to 34 Eur; for non- EU citizens is from 29 Eur to 46 Eur. Minimum number of credits to collect is 30 ECTS credits.

Other expenses: ~ 350 Eur per month.

Private funding Scholarship  If yes, please state the details:

Granting InstitutionFor what period a scholarship has been awarded

Please provide a copy of the Scholarship Letter or private Sponsorship Letter.

VII. ACCOMMODATION

Will you need accommodation at Mykolas Romeris University Student residence hall “Student house” (Didlaukio 57, LT – 080303 Vilnius)? Please note, that accommodation will be provided only if available for the requested period.

Yes  I agree to share a room with other student (-s) Monthly rent is: 200 LTL

No  I will arrange accommodation myself (living address will be …………………………………)

I hereby certify that the answers given by me to the foregoing questions and all statements made by me in this application are true and correct. I understand that my acceptance and matriculation may be cancelled if any statement issued in support of my application is found to be false.

Printed nameSignatureDate, Place

LIST OF ENCLORURES:

  1. Certificate from University confirming the current status of Student.
  2. Copy of your University, College diploma (grades should be included) or official transcript of records of ongoing studies.
  3. Certificate, which explains grading system,used in the academic institutions where you pursued (or expect to pursue) your degree or diploma.
  4. Copy of valid passport (or ID card for EU citizens) page with your photo, date and place of birth, citizenship, date of issue and date of expiration.
  5. A certificate of medical fitness (ensuring the absence of chronological diseases and any other pathology and indicating the results of AIDS test) or copy of EU Medical Insurance Card for EU citizens.
  6. Any other documents, which might be considered for the assessment of your application.

All documents issued in other language than Lithuanian, English, German, French or Russian must be provided with official translations in any of these languages.

PLEASE SEND THIS APPLICATION BY MAIL TO:

International Students Office

Academic Affairs Centre

Mykolas Romeris University

Ateities st. 20,

LT-08303, Vilnius

Lithuania