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 (February – 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

  • Course selection form

  • Document certifying previous higher education

  • Academic transcript documenting your academic work

  • Reference letter from an academic supervisor

  • Passport copy

  • Medical certificate and appropriate health insurance while staying in Ukraine

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:

June 20 for September entry, or

December 15 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 email or fax this form and the supporting documents.


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





U krainian Catholic University Application Page

Semester Abroad Program

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