Lviv polytechnic national university icon

Lviv polytechnic national university




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НазваLviv polytechnic national university
Дата15.08.2012
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LVIV POLYTECHNIC NATIONAL UNIVERSITY

Application form for admission


  1. Surname (family name)

  1. First name(s)

3. Middle name

  1. Date of birth (year-month-day)




5. Place and country of birth

6. Nationality

  1. Sex:

□ Male □ Female

  1. Marital status:

□ Single □ Married

  1. Father’s name




10. Mother’s name

  1. Passport number




12. Date of issue


13. Passport is valid until


14. Permanent home address:

Zip


Country


City


Street, house&flat №


Telephone


15. Permanent home address of parents:

Zip

Country


City


Street, house&flat №


Telephone


16. Address for sending an invitation for studying:

Zip


Country

City


Street, house&flat №


Telephone


17. Employment and profession of parents


18. Name of secondary school you’ve graduated from


19. Date of graduation

20. Other educational institutions, courses you’ve attended (optional)


21. Enrollment: □ Bachelor degree (4 years)

□ Preparatory Department for learning the language (1 year) □ Master degree (2 years)

22. Planned year of enrollment

23. Language which you have chosen for studying at the Preparatory Department:

□ Ukrainian □ Russian

24. Base trend of training at the Preparatory Department

□ Engineer-Technical □ Architectural

□ Medico-Biological □ Chemical

25. Chosen speciality


26. Foreign languages which you know:

□ English □ French

□ German □ Spanish

27. Country of visa registration in Ukrainian embassy


28. E-mail

28. Date of filling in


29. Signature

Note: While sending this application form you should enclose copy(-ies) of passport and copy(-ies) of the certificate about education

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