MINISTRY OF FOREIGN AFFAIRS SCHOLARSHIP APPLICATION FORM FOR STUDY IN THE CZECH REPUBLIC

Please type or complete in BLOCK CAPITALS. PERSONAL INFORMATION Name and surname Sex Date and place of birth Marital status Home address Contact address (if different from above) E-mail Phone Present occupation Name and address of current educational institution/employer ACHIEVED EDUCATION - HIGHEST LEVEL School/University Duration Field of Study Qualification obtained (Please note you must provide a certificate of your qualification) Other Education

LANGUAGE COMPETENCE (excellent, good, fair)

READING ENGLISH CZECH

SPEAKING

WRITING

STUDY YOU WISH TO APPLY FOR Academic year Proposed duration of study Level of study (mark with X) Field of Study University, Faculty (optional) 1. 2. 3. 4. Other information Bachelor (3 years) Masters (5 years) Masters (2 years) PhD.

2010/2011

How did you find out about the scholarship?

WHY DO YOU WISH TO STUDY IN THE CZECH REPUBLIC AND WHAT WOULD MAKE YOU A SUITABLE CANDIDATE? (Please write around 500 words)

OTHER INFORMATION YOU WANT US TO KNOW (optional)

Signature:

Date and place: