Educational Information

INTERNATIONAL STUDENT APPLICATION FORM

ALL sections must be completed. Please, print clearly using block letters. Enclose one set of supporting documents with this application – all documents must be originals or certified copies. This application will not be processed unless full documentation is attached.

1. Personal Details

Family name (as shown on student passport): Sighted.............................................................................

Given Name(s) (as shown on student passport): Falcon..........................................................................

Nationality: Peruvian......................................................................................................................................

Date of birth (dd/mm/yyyy): 24/05/1932.................................. Gender (M/F): M.............................................

Place of birth (country, city): Peru, Huacachi.........................................................................................................

Passport Number: 777777777...........................................................................................................................

Date of Issue (dd/mm/yyyy): 20/8/1950........................... Date of Expiration (dd/mm/yyyy): 20/8/2050...................

Applicant Contact Details

Phone: [phone]............................................................. Mobile: [phone].................................................................. E-mail: wisdom_of_ancient [e-mail].............................................................................................................................................

Full Home address

Number & street: Calle Juan C. Cavero 113............................................................................................................................

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City/town/village name: Huacachi.................................................................................................................. State/ Region: Huacachi District..................................................................................................................................

Post/zip code: 8797779.............................................. Country: Peru..................................................................

Mailing address (if different from above)

Full Home address

Number & street:............................................................................................................................

...........................................................................................................................................................

City/town/village name:.................................................................................................................. State/ Region:..................................................................................................................................

Post/zip code:............................................... Country:..................................................................

Educational Information

(Information about home institution you presently attend or have attended)

Name of Institution: Peruvian Institute of Space Exploration........................................................................................................................

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Full Address: Peru, City Lima, Calle Juan C. Cavero 23...................................................................................................................................

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Telephone Number: [phone]........................................................................................................................

Fax Number: [phone]...................................................................................................................................

Degree/Diploma/Certificate: Master's degree..........................................................................................................

Attendance dates (from-to): 1/9/1950-31/8/1964...........................................................................................................

Completion / expected completion date:.......................................................................................

4. Russian Language Proficiency

Please tick the appropriate box to indicate your Russian language level:

None Basic Good Advanced <- this

NB! You are eligible for a degree programme or any other course only under the condition that your Russian language proficiency is equivalent to TORFL-1, i.e. Test of Russian as a foreign language, 1^st level. Otherwise you can take a pre-admission course of Russian at our Centre for International Education (http://www.cie.krasu.ru/progr.htm).

5. Study Programme at Siberian Federal University

Please, tick the appropriate box to indicate the type of the programme and the department you apply for:

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Дата добавления: 2015-07-26