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

Назва	Application Form for participant in mobility within the Tempus cd jep 23250-2002
Дата	03.08.2012
Розмір	48.21 Kb.
Тип	Документи

Зміст

Data of passport for foreign trips
English part
Annex to the application form
Start. year
Start. year
Start. year

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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