“security in Danger – Safety at risk”

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: [e-mail].

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:
Graduation year:
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

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):

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

[e-mail] by June, 14 2015

Дата добавления: 2015-08-27