1. Personal data:

Family name:

First name:

Date of birth: - -

Place of birth:

Sex: Male Female

Father`s (first) name:

Mother`s (first) name:

Citizenship:

Passport No.:

Address (COUNTRY/ CITY/ POSTAL CODE/ STREET/ HOUSE NUMBER):

Email address:

Phone number:

I AM:

A UNIVERSITY STUDENT

A UNIVERSITY EMPLOYEE

NAME OF YOUR UNIVERSITY - in English (CITY / COUNTRY):

FACULTY AND DEPARTMENT:

POSITION (only for university employees): 

FIELD AND CURRENT YEAR OF STUDY (only for students): 

2. What is your motivation to participate in the course in Poland?

3. Scientific achievements; connections with Poles, Polish language and Polish community abroad

4. I declare that applying for the course at The School of Polish Language and Culture of The John Paul II Catholic University of Lublin is my FIRST CHOICE (I care most about the course at KUL in Lublin):

YES

NO

5. For the NAWA SUMMER COURSE I also apply to (please state city):

6. Previous NAWA SUMMER COURSES (if applies, please state city and year):

7. Rate your knowledge of the Polish language:

speaking: none poor fair good

reading: none poor fair good

writing: none poor fair good

8. Knowledge of other foreign languages:

9. Important health/allergy information you wish to communicate to the school administration office

10. Preferred diet:

11. I declare that I will possess a valid health insurance for the period of my stay during the course including coverage for any costs of transportation to the country of residence

12. Name and telephone number of a person to be notified in case of emergency::

13. For transfer of credits, supply complete address of your school`s Registrar:

14. Consent for data processing: (PDF)

15. Declaration of consent to the processing of personal data in the form of photographs, video and audio: (PDF)

16. Regulations: