Application Form for participant in mobility within the Tempus cd jep 23250-2002 icon

Application Form for participant in mobility within the Tempus cd jep 23250-2002




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НазваApplication Form for participant in mobility within the Tempus cd jep 23250-2002
Дата03.08.2012
Розмір48.21 Kb.
ТипДокументи

Application Form

for participant in mobility within the Tempus CD_JEP 23250-2002

Master of Business Administration & Information Technology”

English part


(to be filled in according to the passport for the foreign trips)

Ukrainian part

(to be filled in according to the Ukrainian passport)

*Name:

Ім’я:




По-батькові:

*Surname:

Прізвище:

*Sex: □Male □Female

Стать: □Чоловіча □Жіноча

*Date of Birth (dd/mm/yyyy):

Дата народження (дд/мм/рррр):

*Place of Birth:

Місце народження:

*Permanent home address,:

Постійна домашня адреса:

**Home phone:

**Домашній телефон:

^ Data of passport for foreign trips

*Foreign passport №

*Date of issue (dd/mm/yy):

*Date of expire (dd/mm/yy):

*Authority:


Additional information:

^ English part

Ukrainian part

*Title:

Наукове звання:

*Degree:

Науковий ступінь:

*Position:

Посада:

*Department:

Кафедра:

*Faculty:

Факультет:

*Scientific interests:

Наукові інтереси:

*Subject within MBA&IT:

*Дисципліна в проекті MBA:

*E-mail(s):

**Mobile phone: +38

*Information will be sent to EU Partner Universities

** Information will be given to the only Project Manager to speed up contacting participant and will not be given to the third person.


Date: Signature

^ Annex to the application form:

* Spoken Languages:

Language

Level


























Please indicate the period in the reverse order: starting from present and follow to the preceding period.

*Education:

^ Start. year

End. year

Institution, degree

City, Country





















































































*Research:

^ Start. year

End. year

Institution, topic

City, Country









































































*Teaching (years, institution, subjects, city, country):

^ Start. year

End. year

Institution, topic

City, Country













































































































*Selected publications:

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