APPLICATION FORMEuroleague for Life Sciences – Summer School 2015

“Make rural world attractive – different actors for rural development”

Economics, Management and Social Sciences: Their Application in Rural Development

July 5 – July 11, 2015 in Kociszew, Polandorganised by WULS (Warsaw University of Life Sciences) in cooperation

with BOKU Vienna, CULS Prague, LIFE Copenhagen, SLU Uppsala, University Hohenheim, Wageningen UR

Please complete this form in BLOCK LETTERS and

send it by email to Anna Odziemkowska: anna_odziemkowska@sggw.pl

with a copy to Nina Drejerska: nina_drejerska@sggw.pl

Application deadline: April 26, 2015

Personal data

Family name: Gender: male female

First name(s): Date of birth: / / day / month / year

Special needs: (e.g. vegetarian, food intolerances etc.)

Current address

Street & No.:

City:

Postal Code: Country:

Email address:

Phone No.: Fax No.:

Academic profile

Home university, faculty/department/unit:

Degree presently pursued / Major field(s) of study:

Language proficiency in English:Indicate level Poor Moderate Good

Topics of your master degree thesis and the abstract/summary of the main ideas in the thesis (one paragraph maximum; 100-150 words):

Short expectations from the summer school (one paragraph):

SIGNATURE OF APPLICANT

I wish to apply for the joint ELLS course “Make rural world attractive – different actors for rural development” Economics, Management and Social Sciences: Their Application in Rural Development organised by WULS.

I hereby confirm that the above information is correct.

Date: Signature:

FOR STUDENTS FROM ABROAD

Contact person in case of emergency

Family name:

First name(s):

Relationship:

City:

Postal Code: Country:

Email address:

Phone No.: Fax No.: