Application form this application form and the supporting documents become the property of ucu icon

Application form this application form and the supporting documents become the property of ucu




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SEMESTER ABROAD PROGRAM

APPLICATION FORM


This application form and the supporting documents become the property of UCU.

Please fill out this form in MSWord (use cursor to move from field to field) or write legibly in printed letters.

Do not use staples to attach anything to this form.





Year of entry



Full Year (September – May) □ Spring Semester (January – June) □

Fall Semester (September – December) □


^ 1. PERSONAL INFORMATION


    1. Last name




Please attach a recent photo

^ 1.2. First and middle names

1.3. Date of birth (dd/mm/yy)


1.4. Place of birth

1.5. Gender

Male □ Female □

^ 1.6. Family Status

Single □ Married □

1.7. Citizenship

1.8. Place of residence


^ 2. CONTACT INFORMATION


2.1. Permanent Home Address This address will be used for all written documentation


2.2. City/Town


2.3. Postcode


2.4. Country


2.5. E-mail


2.6. Telephone (including code)


2.7. Fax (including code)


2.8. Emergency contacts

1

2

Full name







Relation

Father / Mother / Guardian /Other

Father / Mother / Guardian / Other

Address







Telephone (including code)







Occupation







E-mail










3. PASSPORT

3.1. Passport number


3.2. Issue date

3.3. Expiry date

3.4. Country of issue


3.5. City of issue



^ 4. PRESENT ACADEMIC STUDY


4.1 Are you presently enrolled in study? Yes □ No □


4.2. Degree / Qualification


4.3. Undergraduate or postgraduate


4.4. Entry year

^ 4.5. Graduation year

4.6. University / College


4.7. Faculty


4.8. Address of university

4.9. City

4.10. Postcode


4.11. State


4.12. Country

4.13. Phone


4.14. E-mail (university)

4.15. Fax



^ 5. ACADEMIC QUALIFICATIONS HELD


Degree

Field of study

University, city, faculty

Period (years)

Year obtained

5.1.














5.2.














5.3















^ 6. LANGUAGE PROFICIENCY


Language

Level of proficiency

6.1.


Native language

6.2.





6.3.





6.4.






^ 7. SUPPORTING MATERIALS



Please provide the following documents together with your application form:

  • Personal statement

  • Academic transcript documenting your academic work

  • Reference letter

  • Passport copy


If any of the above are not sent with your application form it may delay your application.


Deadline

It is your responsibility to ensure that this application form and all the supporting materials are submitted by the appropriate deadline:

May 31 for September entry, or

December 10 for entry in February of the following year.




^ 8. DECLARATION AND SIGNATURE



I confirm that the information provided in this application form is true, complete and accurate and no information requested has been omitted.

I understand the costs involved in attending the Ukrainian Catholic University and accept that it is my responsibility to meet these costs. I understand that failure to settle all debts will result in my transcript being withheld and not released until any such debts are paid in full.


Date ...................................................... Signature of applicant ........................................................




Please fax or email this form and the supporting documents. The originals must be sent by post.


The International Academic Relations Department

Ukrainian Catholic University

Il. Sventsitskoho str. 17

Lviv 79011

UKRAINE


Tel: +38 032 2409940

Fax: +38 032 2409950

Email: semester_abroad@ucu.edu.ua

Web: www.ucu.edu.ua





Ukrainian Catholic University Application Page

Semester Abroad Program

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