Application form

for International Semester

Personal data

Last name

First name

Other name

Sex

Citizenship

Address

Phone

E-mail

Marital status

Date of birth

Place of Birth

Passport number

Date of issue

Emergency contact

Name

Mailing address

Phone

E-mail

Education

School, College, Universities Major Dates Degree

Language proficiency

Mother tongue

Russian language skills:

Reading
Understanding
Speaking
Writing


Where have you learn Russian language? (indicate institution and duration of study)

What other languages do you know?

Length of studies

I will apply for the following period/ Please mark the desired alternative
 Fall 2011 Spring 2011 Two semesters (academic year)

Date of arrival

Accomodation

I would like to get a room in a student dormitory  Yes No

I will arrange accommodation myself  Yes No

Home Institution

Name

Coordinator

Mailing address

Phone

Fax

E-mail

Supposed place of visa receipt (city/town)