!!!SAMPLE!!! APPLICATION FORM Please fix one

!!!SAMPLE!!!
APPLICATION FORM
for admission to the University of Potsdam as a
program student - without obtaining a degree
Please fix one
passport
photo here
and include
another one
( 3 x 4 cm )
Please fill out in block letters or by computer and print.
I apply to enrol in
Winter semester 20__ / 20__
Application deadline: July 15
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Summer semester 20__
Application deadline: January 15
PERSONAL DATA
LAST NAME
Family name(s) - as stated in your passport or identity card
FIRST NAME
Given name(s) - as stated in your passport or identity card
DD-MM-YYYY
Date of birth (Day – Month – Year)
CITY, STATE
COUNTRY OF BIRTH
Place of birth
Country of birth
COUNTRY OF CITIZENSHIP
Country of Citizenship - please specify all if more than one
Sex
male
female
PROGRAM DATA Please cross off.
Erasmus
DAAD
InWEnt
Fulbright
DHF / UFA
Free Mover
EAP
University
Other - Please specify institution
Partnership
granting the stipend:
HOW LONG DO YOU PLAN TO STAY AT THE UNIVERSITY OF POTSDAM?
1 Semester
01-04-2013
From _________________________
13-7-2013
Till ______________________________
2 Semesters
(Day – Month – Year)
(Day – Month – Year)
BEARBEITUNGSVERMERKE To be filled out by the staff of the University of Potsdam.
Matrikel-Nummer:
Koordinator:
Info-Brief:
Photos:
Nominierung:
UPrepare:
DK-Antrag:
DK-Teilnahme:
LA:
LA zurück:
HZB:
Tandem:
AE bis:
KV bis:
1
CURRENT ADDRESS
DD-MM-YYYY
This address is valid until (Day – Month – Year)
YOUR NAME
c/o
STREET ADDRESS
Street, House number, Apartment number
POSTAL CODE
Postal code
CITY
City
STATE, COUNTRY
State/ Country
COUNTRY CODE IS 001 - THEN ENTER YOUR PHONE NUMBER ex. 001-555-555-5555
Telephone number (Country code – City code – Phone number)
ENTER YOUR UC EMAIL ADDRESS AND A PERSONAL EMAIL ADDRESS SUCH AS GMAIL, YAHOO, ETC.
E-mail-address
PERMANENT ADDRESS Please fill out only if different from current address
YOUR NAME
c/o
YOUR PERMANENT ADDRESS
Street, House number, Apartment number
POSTAL CODE
Postal code
CITY
City
STATE, COUNTRY
State/ Country
COUNTRY CODE IS 001 - THEN ENTER YOUR PHONE NUMBER ex. 001-555-555-5555
Telephone number (Country code – City code – Phone number)
E-mail-address
HOME UNIVERSITY
UNIVERSITY OF CALIFORNIA, (ENTER YOUR HOME CAMPUS)
Name of your home university
JILL HARRISON
Contact person for exchange students at your home university
JHARRISON@EAP.UCOP.EDU
E-mail-address of the contact person
ENTER THE NUMBER OF QUARTERS/SEMESTERS YOU COMPLETED AT YOUR UC
How many semesters did you study at your home university until date of application?
2
SUBJECTS PLANNED TO STUDY AT THE UNIVERSITY OF POTSDAM / FIELD OF RESEARCH
ENTER THE SUBJECT(S) MOST CLOSELY RELATED TO YOUR MAJOR(S) (IN GERMAN AND ENGLISH)
Enrollment is possible in 2 subjects at maximum.
List of subjects in which you can get enrolled
Allgemeine Sprachwissenschaft (Linguistics)
Allgemeine und vergleichende Literaturwissenschaft (Literary Science)
Allgemeine Sprachwissenschaft (Patholinguistics)
Anglistik und Amerikanistik (Anglistics and American Studies)
Betriebswirtschaftslehre (Business Administration)
Biochemie (Biochemistry)
Biologie (Biology)
Chemie (Chemistry)
Ernährungswissenschaft (Nutrition science)
Erziehungswissenschaft (Pedagogy)
Europäische Medienwissenschaft (European Media Science)
Geographie (Geography)
Geophysik (Geophysics)
Geowissenschaften (Geoscience)
Germanistik (German language and literature studies)
Geschichte (History)
Informatik (Informatics)
Jüdische Studien (Jewish studies)
Mathematik (Mathmatics)
Musik (Music)
Philosophie (Philosophy)
Physik (Physics)
Politikwissenschaft (Political Science)
Psychologie (Psycholgy)
Rechtswissenschaft (Law)
Religionswissenschaften (Religious studies)
Romanistik (Romance language and literature studies)
Slavistik (Slavic language and literature studies)
Soziologie (Sociology)
Sportwissenschaft (Sports Science)
Verwaltungswissenschaft (Administration Science)
Volkswirtschaftslehre (Economics)
EDUCATIONAL BACKGROUND
ENTER THE YEAR YOU GRADUATED HIGH SCHOOL
In which year did you finish secondary school qualifying for university admission?
Bachelor (or equivalent)
ENTER YOUR MAJOR
Main subject
ENTER YOUR PROJECTED GRADUATION DATE
(planned) date of degree awarded
Master (or equivalent)
Main subject
(planned) date of degree awarded
PhD
Main subject
(planned) date of degree awarded
Fill out this section as appropriate for your previous studies in German.
Have you studied in Germany before?
Yes
If yes, at which university?
from
3
till
No
KNOWLEDGE OF GERMAN LANGUAGE
Do you have German language skills?
Yes
Fill out this section as appropriate for your
knowledge of German language.
No
Where did you study German?
School
University
Language course in Germany (or Austria, Switzerland...)
Rating of your German knowledge skills:
Very good
Good
Satisfactory
Basic skills only
TANDEM
Would you like us to find you a tandem partner?
Yes
No
Tandem partners are students from the University of Potsdam who volunteer to assist you before and
upon your arrival in Potsdam and at the university. For more information, please refer to the tandem
project's website: http://www.uni-potsdam.de/aaa/tandem/tandem_en.html
WRITE YOUR CURRENT CITY, STATE
Place
DATE
Date
DON'T FORGET TO SIGN!!!
Signature
------------------------------------------------------------------Please send your application to the following address:
---------------------Universität Potsdam
Akademisches Auslandsamt
-------------------------------Am
Neuen Palais 10
----------------------14469
Potsdam
----------------Germany
-----------
Do not send your application to Potsdam!
You must send it to the UCEAP Systemwide Office!
Please hand in with the application form:
- Certificate of stipend or nomination from your home university or an invitation from a professor of the
------------------------------------------------------------------------------------------------------------------University of Potsdam You do not need to submit this certificate.
------------------------ 2 passport-sized photos in colour (3 x 4 cm) for your student identity card
When we have received your complete application, either after the beginning of August (for the
coming winter semester) or after the beginning of February (for the coming summer semester), we will
send you a confirmation of admission along with all necessary information pertaining to your arrival
and enrolment at the University of Potsdam. Please do not make any inquires before.
Make sure you give us a valid address so that our postal mail will reach you in August (for the coming
winter semester)/ February (for the coming summer semester).
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