APPLICATION FORM FOR INTERNATIONAL EXCHANGE STUDENTS

Application should be completed on a computer and sent in electronic version

to kbaron@pk.edu.pl

FULL NAME (as in Passport)
First Name/ Names (as in passport)	Surname/ Surnames (as in passport)
Semester of Studies (while on exchange) – 1st, 2nd, etc. - choose	click to choose
GENDER	Female ☐ Male ☐
PASSPORT NUMBER/ Date of expiry
Date of Birth (day/month/year)	click here to choose date
Place of birth (exact name of a city / village)
Mother's first name/ Father’s first name
Nationality (as in passport)
Permanent address
Address for correspondence (if different from above)
Telephone number
e-mail address
HOME UNIVERSITY (full name)
Department
Contact person at Home University
e-mail address
Telephone number/ Fax number
Correspondence Address of International Relations Office at Home University for sending the Transcript of Records
Intended period of stay at Cracow University of Technology
SEMESTER at CUT 1st semester – Oct. – Feb. or 2nd semester – Feb. - June	1st semester ☐ 2nd semester ☐
PURPOSE OF STAY	courses ☐ final project ☐
Preferred courses to take at Cracow University of Technology (please list at least 8 units of your choice as alternatives may be required)
1st semester – October - February	click and choose Faculty from the list
1.
2.
3.
4.
5.
6.
7.
8.
2nd semester – February - June	click and choose Faculty from the list
1.
2.
3.
4.
5.
6.
7.
8.
LANGUAGE COMPETENCES
MOTHER TONGUE
ENGLISH LANGUAGE (poor/good/fluent)
ACOMMODATION*
ACCOMMODATION (Students' hall of Residence)	required ☐ not required ☐
accommodation from (day/month/year)	Accommodation until (day/month/year)
click and choose date of check in 16/09/2017	click and choose date of check out 15/02/2018

*Accommodation

The International Relations Office (IRO) offers assistance in finding accommodation for short-term students in CUT student dormitory. A student who wishes to have university accommodation must state that in the Application Form.

Please note that place in a double room will be booked based on the information submitted by you in the Application Form.

The number of places in university dormitories is limited and therefore accommodation is assigned on a „first come first served” basis. A place in a dormitory is assigned for a whole duration of studies at CUT.

Please note that once you receive a place in a dormitory, you will be obliged to transfer PLN 300* to a bank account number which will be sent to you via e-mail by the dormitory administration. In order to confirm your reservation the money needs to be transferred by a date given in the e-mail you will receive.

Changes to the booking: After 1 September (fall semester) and 1 January (spring semester) changes to the booking are not possible.

Cancellation of the booking: If you cancel your booking after dates mentioned above, you will be obliged to pay PLN 300. If you resign from accommodation in students’ hall during your stay in Cracow please inform about that your dormitory manager and CUT International Relations Office.

Student is obliged to inform administration of the dormitory about check in/ check out.

Please note that if you move in between 16th and the last day of a month or move out between 1st -15th day of a month, you are required to pay PLN 187.5 (rent for a half of the month); if you move in between 1st and 15th or move out between 16th – the last day of a month, you will have to pay rent for the whole month (PLN 375). Only students who arrive before AY begins (in September) pay accommodation fee (for September only) on a daily basis in cash.

* Applicable to students checking in in September or October.

Additional Documents

Upload your passport-sized picture (electronic version)**

**Size of the picture min. 236x295 +/- 3pixels; max. 800x600 pixels

CLICK to upload picture

Please attach scan of your passport (electronic version)

CLICK to upload picture

By submitting this application I certify that the information provided on this application is accurate.

By submitting this Application Form I confirm that I have the acceptance of my Home University Coordinator for the courses I have chosen.

I hereby authorize you to process my personal data included in my application for the needs of the recruitment process in accordance with the Personal Data Protection Act dated 29.08.1997 (uniform text: Journal of Laws of the Republic of Poland 2002 No 101, item 926 with further amendments).