ROCIO MOTOS CHECA; Generated on 2011-08-29 21:56
University of Warsaw International Relations Office Krakowskie Przedmieście 26/28, PL 00-927 Warsaw, Poland
APPLICATION FORM ACADEMIC YEAR 2011-2012 1. Status at University of Warsaw:
Erasmus Student (studies)
2. Period of stay: 2nd semester 3. Personal details: Name: ROCIO Date of birth: 1991-01-01 Gender: Female Citizenship: Spain E-mail: Rocio.Motos1@alu.uclm.es
Family name:
MOTOS CHECA
Place of birth: CUENCA, Spain Identity document: ID document 04627105B Second citizenship: Spain Phone number: +34 (969) 2083 25 Mobile number: +34 653 874 446
4. Permanent address: C/TRAVESÍA OLMEDA, 15 15, 16120 VALERA DE ABAJO, Spain 5. Correspondence address: Same as permanent. 6. Disability information: No 7. Previous studies Home university: FACULTY OF EDUCATION Level of study: first cycle (BA) Current year of study: 3 Language Skills: 1. English (B1) 8. Accommodation: I intend to apply for university accommodation
For office use only, please do not fill. DECYZJA REKTORA Wyrażam zgodę na przyjęcie na studia częściowe. Wyrażam zgodę na podjęcie kształcenia/studiów, na warunkach finansowych wnioskowanych przez Dziekana/Kierownika jednostki. Nie wyrażam zgody na podjęcie kształcenia/studiów. Podpis ................................................................................ Data ........................
1/2
ROCIO MOTOS CHECA; Generated on 2011-08-29 21:56
9. I intend to study following domains: Education, Teacher Training (05.0) Primary Education (05.2) 10. I intend to study at the following units: University College of English Language Teacher Education 11.I am interested in following this courses: Series of Lectures on Methodology. The Developing Teaching Skills Course (4101-5SDUMO) Teaching skills (4101-3SPUNJAO) The Academic Reading Course (4101-1SCAO) The Culture and History of England Course (4101-1SKHAO) The Educational Psychology Course (4101-1SPEO) The Pedagogy Course (4101-2SPGO)
HOME INSTITUTION (ERASMUS CODE......................................... Discipline code ............. -- if applicable) Name and address .................................................................................................................... ...................................................................................................................................................... Departamental/institutional coordinator (name, telephone, fax, e-mail): ..................................................................................................................................................... ..................................................................................................................................................... .....................................................................................................................................................
I declare that that this student has been selected by this institution for Erasmus exchange/bilateral exchange and that the information provided on this form is correct. Signature:....................................................................... Date:..................................
Stamp of the institution...........................................................................................
Student's signature:..................................................................... Date:..............................
2/2