Erasmus student full degree student Other . (specify)

ACCOMMODATION FORM*

ACADEMIC YEAR: 2015/2016

STUDENT PERSONAL DATA

Surname: ……………………………………………. First name(s): …………….……………………………………

Sex: male female

Nationality: …………………………………………

ID card: ………………………………………………. Passport number: ……………………………………………..

E –mail address: ………………………………………

STATUS AT PUT

Erasmus student full degree student Other ………………………………………. (specify)

Faculty at PUT: ………….……………………………………………

ACCOMMODATION AT PUT

Time you would like to stay in the PUT dormitories in the academic year 2014/2015

(The exact date of the arrival should be reported to the Lifelong Learning and International Education Office later on. Please note, that we can offer the accommodation after 15^th of September in the winter semester and from 29.02.2016 in the summer semester. If possible we accept earlier arrivals but they should be reported and agreed with PUT LLL and International Education Office. If you apply only for the winter semester only, the maximum departure date should be end of the semester, that is 26.02.2015)

from....../……./….……. to......./….…/………….

day / month / year day / month / year

OTHER INFORMATION

Do you have any special accommodation needs related to your state of health/disability?

Yes No

If yes, please specify ……………………………………………………………………………………………………………

Signature of the student ……………………………………. Date …………………………………

*Applications for accommodation will be accepted on a first-come, first- served basis.)

Дата добавления: 2015-11-04