Please read the Guidance Notes to Applicants before completing
the form. Complete the form in CAPITAL letters and black ink.
1. Language of study:
Polish (you would like to participate in one year of the
preparatory Polish language course and pass an examination)
English
Applicants number(to be flled by WrUT )
2. Proposed degree of study and the year of start:
Faculty name
Field of study / programme
3. Personal details
Surname / Family name
First names
Country of birth Male Female
Polish descent Date of birth Y Y Y Y M M D DCitizenship Passport
number
Country of permanent residence
Permanent home address
Home telephone
Mobile
Fax
e-mail
Correspondence address (if diferent)
Telephone
Mobile
Fax
e-mail
4. Information on previous education
Secondary School
From Y Y Y Y To Y Y Y YUniversity
From Y Y Y Y To Y Y Y YUniversity
From Y Y Y Y To Y Y Y YSecondary School / University
(if university include subject of study)Qualifcation
(include grade)Date obtained
Y Y Y Y M M D DY Y Y Y M M D DY Y Y Y M M D D
PERSONAL DATA IS UNDER PROTECTION!
Polish (you have the required level of Polish language
competency)
APPLICATION FOR ADMISSIONto studies in the academic year 2 0 Y Y
Y
Bachelor Master October intake February intake
Y
Yes No
(you would like to participate in one year of preparatoryEnglish
language course and pass an examination)
English(you have the required level of English language
competency)
5. English language competency*
Grade / score Date of examination
Y Y Y Y M M D DY Y Y Y M M D DY Y Y Y M M D D
*Applicants whose frst language is not english should have the
required level of english competency for their proposed degree of
study.
Name of test
IELTS
TOEFL
6. Work experience (include voluntary work)
Nature of WorkDateEmployer
7. Finance: How do you plan to fund your studies?
I have a scholarship/grant
(Please give the name of the individual or organization funding
your scholarship/grant)I (or my family) will be funding my
studies.
Other sources of funding studies
8. Other relevant information
Disability / special needs
Contact in case of emergency (person/telephone)
9. Accommodation
Do you wish to book a place in a student hall of residence? Yes
No
10. Declaration
I agree to abide by the University Regulation.I confrm that, to
the best of my knowledge, the information given in this form is
correct and complete.
Signature of Applicant Date Y Y Y Y M M D D
12. Attachments
For Bachelor studies: a copy of the secondary school certifcate
(in English or Polish)
For Master studies: a copy of BEng / BSc / BTech degree
certifcate (in English or Polish) and a transcript of records
Complete application form and supporting documents should be
sent to:WROCAW UNIVERSITY OF TECHNOLOGY tel.: + 48 71 320 31 70,
+48 71 320 37 19, +48 71 320 44 39ADMISSION OFFICE 50-370
WROCAW
e-mail: [email protected]
WYBRZEE WYSPIASKIEGO 27 www.pwr.wroc.pl
POLAND
11. Reasons for applying
State here your reasons for applying for studies and any extra
information relevant to your application.
OTHER
