/ POLITECHNIKA WROCŁAWSKA
WROCŁAW UNIVERSITY OF TECHNOLOGY (WUT)
OFFICE FOR EDUCATIONAL AFFAIRS

______

Applicant’s number ...... (to be filled by WUT)

APPLICATION FORM

PERSONAL DETAILS:

Surname:
First name:
Sex: ٱ Male ٱ Female
Nationality:
Date of birth: Country and place of birth:
Passport number:
Correspondence address:
Tel:
Fax:
E-mail address:
EDUCATION BACKGROUND:
Dates of attendance
/
School/University attended
/ Subjects Studied / Qualifications obtained
from
/
to

LINGUISTIC COMPETENCE:

MOTHER TONGUE
EXCELLENT / GOOD / SUFFICIENT / NO
ENGLISH / ٱ / ٱ / ٱ / ٱ
POLISH / ٱ / ٱ / ٱ / ٱ
OTHER / ٱ / ٱ / ٱ / ٱ
ٱ / ٱ / ٱ / ٱ
ٱ / ٱ / ٱ / ٱ
Have you passed any official foreign language exam?

DEGREE QUALIFICATION FOR WHICH YOU WISH TO BE REGISTERED:

(underline your choice)

1.  Ph.D. studies - full-time (6-8 semesters):
2.  Part-time (periodic tutorials)
3.  Doctoral dissertation’s defence without studying in Poland
4.  One year Polish language course at WUT*

STUDIES PROPOSED:

Faculty: Scientific discipline:
Proposed start:
TUITION FEE PAID BY:
□ Yourself □ Your family □ Government of your country □ Others (specify)
ACCOMMODATION:
Do you wish to book a place in a student hall of residence? □ Yes □ No
DECLARATION
I confirm that, to the best of my knowledge, the information given on this form is correct.
I hereby authorize you to process my personal data included in my application form for the needs of the recruitment process at WUT (in accordance with the Personnel Protection Act of 29.08.1997 No 133 position 883).
Applicant’s signature Date

Complete application form and supporting documents should be sent to:

WROCŁAW UNIVERSITY OF TECHNOLOGY
OFFICE FOR EDUCATIONAL AFFAIRS
WYBRZEŻE WYSPIAŃSKIEGO 27
50-370 WROCŁAW / Building A-1, room 153
tel.: +48 71 3203456, +48 71 3203873
fax: +48 71 3286366
e-mail:

*Candidates who wish to study in Polish and do not speak Polish are obliged to participate in the Polish language course before beginning the studies at WUT.