Academic year of mobility (format rrrr-rrrr):

PERSONAL INFORMATION

Name:

Surname:

Date of birth (yyyy-mm-dd):

Place of birth:

Passport number:

Nationality:

Gender:malefemale

Phone number:

E-mail:

PERMANENT ADDRESS

Street:

Home / apartment number:

Postal code:

City:

Country:

CORRESPONDENCE ADRESS (if different)

Street:

Home / apartment number:

Postal code:

City:

Country:

PERSON TO CONTACT IN AN EMERGENCY

Name:

Surname:

Relation:

Phone number:

E-mail:

Street:

Home / apartment number:

Postal code:

City:

Country:

INFORMATION ABOUT STUDIES

Home University:---A GRAZ03 Kunstuniversität Graz (KUG), AustriaKLAGENF02 - Pädagogische Hochschule Kärnten - Viktor Frankl Hochschule, AustriaB EUPEN04 -Autonomie Hochschule in der Deutschsprachigen Gemeinschaft, BelgiaB CHAMPIO02 - HENaC Haute Ecole Namuroise Catholique, BelgiaB NAMUR15 – Haute Ecole de Namur – Liége- Luxemburg, BelgiaB KORTRRIJ01 -VIVES University of Applied Sciences, BelgiaBG BLAGOEV02 – South West University, BułgariaBG PLOVDIV02 - Medical University Plovdiv, BułgariaBG PLEVEN01 - Medical University Pleven, BułgariaBG VELIKO01 - Velikoturnovski University, BułgariaCY LIMASSO03 – The Limassol College, CyprHR OSIJEK01 - Strossmayer University of Osijek, ChorwacjaHR ZAGREB05 -Zagreb University of Applied Sciences, ChorwacjaHR ZADAR01 - University of Zadar, ChorwacjaHR RIJEKA01 – University of Rijeka, ChorwacjaHR ZAGREB05 – Polytechnic of Zagreb, ChorwacjaCZ CESKE01 -University of South Bohemia in České Budĕjovice, CzechyCZ BRNO01-Brno University of Technology, CzechyCZ BRNO05 - Masaryk University, CzechyCZ OPAVA01 - Silesian University in Opava, CzechyCZ ZLIN01 - Tomas Bata University in Zlin, CzechyCZ OLOMUC01 - Univerzita Palackého v Olomouci, CzechyCZ USTINAD01 - Univerzita Jana Evangelisty Purkyne v Usti nad Labem, CzechyCZ PLZEN01 – University of West Bohemia, CzechyDK ARHUS01 - Aarhus University, DaniaDK ROSKILD04 -Zealand Institute of Business and Technology, DaniaDK KOGE03 – Zealand Institute of Business and Technology, DaniaSF LAPPEEN07 - South Karelia University of Applied Sciences, FinlandiaSF LAPPEEN07-Saimaa University of Applied Sciences, FinlandiaSF HELSINK41 – Helsinki Metropolia University of Applied Sciences, FinlandiaE LACORU01 - Universidad de A Coruña, HiszpaniaE ELCHE01 - Universidad Miguel Hernandez de Elche, HiszpaniaE ZARAGOZ01 - Universidad de Zaragoza, HiszpaniaE MADRID05 - Universidad Politecnica de Madrid, HiszpaniaEMADRID160 - Universidad a Distancia de Madrid (UDIMA), HiszpaniaE LEON01 – Universidad de LeonE GRANADA01 – University of Granada, HiszpaniaE MURCIA04 – Universidad Politéchnica de Cartagena, HiszpaniaE VALLADO01 – Univeridad de Valladolid, HiszpaniaE ZARAGOZA15 - CEFOR Izquierdo Zaragoza, Hiszpania F DOUAI12 – Regional Institute of Health and Social Training, French Red Cross, FrancjaF MOULINS07 – IRFSS Auvergre, FrancjaGTRIPOLIO3 - University of the Peloponnese, Grecja G KRITIS04 – Technological Educational Institute of Crete, GrecjaG ATHINE53-School of Pedagogical & Technological Education ASPETE, GrecjaG EGALEO02-University of West Attica, GrecjaG KRITIS05-Hellenic Mediterranean University, GrecjaIRLATHLONE01 - Athlone Institute of Technology, IrlandiaL University of Luksembourg, LuksemburgLT KAUNAS08 - Kauno Kolegija, LitwaLT KLAIPED09 - Klaipeda State College, LitwaLT SIAULIA03 – SiauliaiState College, LitwaLT VILINUS01 – Vilinus University, LitwaLV DAUGAVP02 - Daugvapils Medical College, ŁotwaLV REZEKNE02 - Rezeknes Augstskola, ŁotwaLV VENTSPI01 - Ventspils University College, ŁotwaLV International College of Cosmetology, ŁotwaMK SKOPJE01 -SS.Cyril and Methodius university in Skopje, MacedoniaMK BITOLA01 -St Kliment Ohridski University – Bitola, MacedoniaD BERLIN04 - Beuth Hochschule Fuer Technik Berlin, NiemcyD BINGEN01 - Fachhochschule Bingen, NiemcyD HILDESH02 - HAWK Fachhochschule Hildesheim, NiemcyD DUSSELD01 - Heinrich Heine Universität Düsseldorf, NiemcyD SENFTEN01 - Branderburgische Technische Universität, NiemcyD LEMGO01 - Hochschule Ostwestfalen – Lippe, NiemcyDE ZITTAU02 - Internacionales Hochschulinstitut Zittau, NiemcyD BAMBERG01 - Otto-Friedrich- Universität Bamberg, NiemcyD KASSEL01 - Universität Kassel, NiemcyD HALLE01 - Universität Halle, NiemcyD HEIDELB01 - Universität Heidelberg, Niemcy D MITTWEI01-Hochschule Mittweida, NiemcyN STEINKJ01 – Nord University, NorwegiaP ARCOZEL01 - Instituto Politécnico do Cávado e do Ave, PortugaliaP COIMBRA24 - Escola Superior de Enfermagem de Coimbra, PortugaliaPFARO02 - Universidade do Algarve, PortugaliaP COVILHA01 - Universidade de Beira Interior, PortugaliaP LISBOA106 - Escola Superior de Enfermagem de Lisboa, PortugaliaP EVORA01-University of Evora, PortugaliaRO CLUJNAP01 - Universitatea Babeş – Bolyai, RumuniaRO BUCURES09 - Universitatea din Bucuresti, RumuniaSK BRATISL01 - Slovak University of Technology, SłowacjaSK TRENCIN01 – Alexander Dubčak University of Trenčín, SłowacjaSK NITRA02 – Slovak University of Agriculture in Nitra, SłowacjaSK BRATISL04 – Academy of Fine Arts and Desing Bratislava, SłowacjaSK BRATISL11 – Slovak Mesical University, SłowacjaSK KOSICE04 – University of Security Menagement in Košice, SłowacjaSK RUZOMBE01-The Catholic University in Ruzomberok, SłowacjaSK PRESOV01-University of Prešov, SłowacjaSI LJUBLJANA01 - University of Ljubljana, SłoweniaSI CELJE06 - Environmental Protection Collage, SłoweniaTR BURDUR01 - Mehmet Akif Ersoy University, TurcjaTR NIGDE01 - Nigde University, TurcjaTR SAKARYA01 - Sakarya University, TurcjaTR KUTAHYA01 - Dumlupinar University, TurcjaTR SANLIUR01 - Harran University, TurcjaTR TOKAT01 – University of Gaziosmanpasa, Tokat, TurcjaTR ISTANBU 10 - Istanbul Commerce University, TurcjaTR SIVAS01 - Cumhuriyet University, TurcjaTR ELAZIG01 – Firat University, TurcjaTR GAZIANT03 – Hasan Kalynocu University (HKU), TurcjaTR YALOVA01 – Yalova University, TurcjaTR CANKIRI01- Karatekin University, TurcjaTR AGRI01 -University of Agri, TurcjaTR ANTALYA 04 -Alanya HEP University, TurcjaHU DEBRECEN01 - University of Debrecen, WęgryI COSENZA01 - University of Calabria, WłochyI CARRARA01 - Accademia di Belle Arti Carrara, WłochyPalazzo Spinelli Associazione No Profit, WłochyI ROMA31 Niccolo Cusano University Distance Learning – UNICUSANO, WłochyUK University of Winchester, Wielka BrytaniaUK Edge Hill University-Paramedic Team, Wielka BrytaniaInna uczelnia …UA-Lviv University in UkraineIN University of Pune (Indie) UA Lviv Polytechnic National University (Ukraina) Dostoevsky Omsk State university, RosjaSuranaree University of Technology, TajlandiaCanadian Institute of Technology- Tirana, AlbaniaUniversity of Tirana, AlbaniaPolytechnic University of Tirana, AlbaniaAhmedabad University Public Trust, IndieSavitribai Phule Pune University, IndieASM Group of Institutes Pune, IndieInstitut Teknologi Sepuluh Nopember, IndonezjaUniversity of Montenegro, CzarnogóraUniversity of Mostar, Bośnia i HercegowinaUniversum College, KosowoUniversity of Prishtina “Hasan Prishtina”, KosowoCETYS University, MeksykThe University of Texas Rio Grande Valley, USASuranaree University of Technology, TajlandiaIvan Franko National University of Lviv, UkrainaLviv Polytechnic National University, UkrainaTernopil Ivan Puluj National Technical University, UkrainaKharkiv National Agrarian University, UkrainaOdessa National Economic University, UkrainaUkrainian Engineering Pedagogics Academy, UkrainaOther

Faculty:

Field of study:

Number of study years competed prior to departure abroad:IIIIII

Contact person in home University:

Function:

Phone number:

E-mail:

Host faculty:---Institute of ArchitectureInstitute of Internal SecurityInstitute of DieteticInstitute of FinancePsychopsychical CoachingInstitute of Computer ScienceInstitute of JazzInstitute of CosmetologyInstitute of PhilologyInstitute of NursingInstitute of ManagementInstitute of Emergency Rescue

LANGUAGE SKILLS

Mother language:

English language (level):A1A2B1B2C1C2

German language, Czech language, Spanish language, other:noyesGermanCzechSpanishOtherA1A2B1B2C1C2

Have you already been studing abroad?yesno

Planned period of study:winter semesterspring semesterfull academic year

Accommodation in dormitory requested:yesno

I decelerate that I will take part in Polish Language Course organised by the University of Applied Sciences in Nysa and cover the appropriate costs according to the information package (obligatory for medical faculties students)---yesno

Other comments or wishes: