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Summer School
“SECURITY IN DANGER – SAFETY AT RISK”
June 24-26, 2015
(2, Velyka Zhytomyrska Str., Kyiv)
APPLICATION FORM
In order to be considered for participation in the Summer School “Security in Danger – Safety at Risk” please fill out an application form by June 14 2015. Notification about selection results as well as consent forms will be sent to you by e-mail on June 16 2015. For more information do not hesitate to contact the School Administration Board via e-mail: summerschool.dau@gmail.com.
1. PERSONAL DATA
Family Name: | City/town: | ||
First Name: | Telephone number: | ||
Date of Birth: | MM.DD.YYYY | E-mail: |
2. ACADEMIC INFORMATION (please mention only the most recent academic experience):
University / Institution: | |
Year of Study and Course: | |
Specialty: |
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Graduation year:
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Research interests (if any) |
3. PROFESSIONAL INFORMATION (please mention only the most recent professional experience):
Organization / Institution: | |
Job title: | |
Short description of work experience: |
4. FOREIGN LANGUAGES SKILLS
Language | Level (A1-C2 or beginner - proficiency) |
English | |
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5. Briefly outline YOUR MOTIVATION for participation in the Summer School “Security in Danger – Safety at Risk” and what you would like to gain by attending it (do not exceed 200 words):
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6. ACCOMODATION
Would you like to apply for accommodation?
Yes: No:
7. SOURCE OF INFORMATION. How did you find out about this Summer School(please name internet source, institution, person)?
__________________________________________________________________________
8. RECOMMENDATION. Please provide us with a name, title and contact details of your scientific supervisor, tutor, lecturer who recommended you to participate in this Summer School.
__________________________________________________________________________
9. By filling this application form according to the Law of Ukraine “On Personal Data Protection” I agree on processing my personal data.
Yes: No:
10. CURRICULUM VITAE. Please attach your 1-page CV
Please send this application form to
summerschool.dau@gmail.com by June, 14 2015
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