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: | ^ | *Foreign passport № | *Date of issue (dd/mm/yy): | *Date of expire (dd/mm/yy): | *Authority: |
Additional information: ^ | 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 ^ * Spoken Languages:
Please indicate the period in the reverse order: starting from present and follow to the preceding period. *Education: ^ | End. year | Institution, degree | City, Country |
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| *Research: ^ | End. year | Institution, topic | City, Country |
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| *Teaching (years, institution, subjects, city, country): ^ | End. year | Institution, topic | City, Country |
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| *Selected publications: |