PREŠOVSKÁ UNIVERZITA V PREŠOVE
Nám. legionárov č. 3, 080 01 Prešov

ECTS - Európsky systém transferu kreditov
ECTS – EUROPEAN CREDIT TRANSFER SYSTEM

Prihláška na výmenné štúdium
STUDENT EXCHANGE STUDY APPLICATION FORM

										  
                                                                                                	
                                                                                                               Fotografia
                                                                                                                 (PHOTO)
AKADEMICKÝ ROK: ……/……
(Academic Year) 
ŠTUDIJNÝ ODBOR: ………………………………
(Study branch): ……….......................................................……

Vyplňte čiernou farbou, aby sa uľahčilo kopírovanie a faxovanie.
(Fill in black to facilitate copy and telefax.)
Vysielajúca vysoká škola (Delegating higher education institution)
Názov a celá adresa:
(Name and full address):    

…………………………………………………………………………………………............................................ 
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...............................................................................................................................................................….

Fakultný koordinátor – meno, telefón, fax, e-mail:
(Facultyt coordinator – name, telephone and telefax numbers, e-mail box):  

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Inštitucionálny koordinátor – meno, telefón, fax, e-mail:
(Higher education institution coordinator – name, telephone and telefax numbers, e-mail box): 

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Osobné údaje študenta (vypĺňa študent)
STUDENT’S PERSONAL DATA (to be completed by the student applying)

Priezvisko  (Family name):
...……………………………………………...……

Dátum narodenia: ………………………....…..…
(Date of birth):
Pohlavie (Sex): …………………………………….......
Štátna príslušnosť  (Nationality): ...............................
Miesto nar. (Place of Birth): ..........................….......
Súčasná adresa (Current address): ................................................…………………......
........................................................................…......
.........................................................................….....
........................................................................…......
Adresa platí do (Address is valid until): ……….......
Tel.:...........................................................………...	Meno (First name):
…….……………………………………………

Trvalý pobyt (ak je adresa odlišná):
[Permanent address (if different)]:
.............................................................................
.............................................................................
.............................................................................
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Tel.: ....................................................................	

Zoznam inštitúcií, ktoré dostanú túto prihlášku
(v poradí podľa preferencie)
LIST OF INSTITUTIONS RECEIVING THIS APPLICATION FORM (in order of preference)

Inštitúcia
(Institution)
	Krajina
(Country)	Obdobie štúdia
(Period of study)
OD (from)  DO (to)	Trvanie
(v mes.)
Duration of stay    (months)	Očakávaný počet kreditov
(N° of expected credits)	
1......................................
2......................................
3......................................	....................
....................
.....................	............
............
............	...........
...........
............	...................
...................
......................	............................
............................
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Meno a priezvisko študenta (Full name of student): ............................................................................................................................................………………
Vysielajúca vysoká škola (Delegating institution):
...........................................................................................…………………………………………….…
Krajina (Country): .....…………………………………….......................................…………...………..	

Stručne vysvetlite dôvody, prečo chcete študovať v zahraničí.
(Briefly explain the reasons why you wish to study abroad.)
....................................................................................................................................................................
....................................................................................................................................................................
……………………………………………………………………………………………………………
...................................................................................................................................................………….	

Jazykové znalosti
Language Competence
Materinský jazyk (Mother tongue):……………………..……………………………………………….
Jazyk, v ktorom študent študuje na domácej vysokej škole (Language of instruction at home higher education institution ): ...............................................................................................................................................	
Iné jazyky
(Other languages)	V súčasnosti študujem tento jazyk
(I am currently studying this language)	Môžem študovať v tomto jazyku
(I have sufficient knowledge tostudy in this language)	Po príprave by som mohol študovať v tomto jazyku
(I could study after extra preparation)	
	áno/ yes	nie/ no	áno/ yes	nie/ no	áno/ yes	nie/ no	

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Pracovné skúsenosti spojené so súčasným štúdiom
WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)

Typ práce
(Type of work experience)

............................................
............................................	Podnik/Organizácia
(Firm/Organisation)

……………………………
………………….…………	Dátum
(Date)

...........................
............................	Krajina
(Country)

...............................
...............................	

Predchádzajúce a súčasné štúdium
PREVIOUS AND CURRENT STUDY
Akademický titul po skončení súčasného štúdia:
(Diploma/degree for which you are currently studying):..............................................................…………………...
Počet skončených ročníkov pred odchodom na študijný pobyt:
(Number of higher education study years prior to departure abroad): ........................................................…………
Študovali ste už v zahraničí?
(Have you already been studying abroad?)                áno             nie 
                                                                                         (yes)                   (no)
Ak áno, kedy?  Na akej inštitúcii?               
(If yes, when? At which institution?) ....................................................................................................................

Priložený Výpis výsledkov štúdia obsahuje detaily o predchádzajúcom a súčasnom štúdiu. Údaje, ktoré nie sú známe v čase podávania prihlášky, budú doplnené dodatočne.
(The attached Transcript of records includes full details of previous and current higher education study. Details not known at the time of application will be provided at a later stage.)	

Chcete požiadať o  mobilitný grant, ktorý by pokryl Vaše dodatočné výdavky počas študijného pobytu v zahraničí?
(Do you wish to apply for a mobility grant to assist towards the additional costs of your study period abroad?)
                                                                        áno           nie 
                                                                                (yes)                 (no)	

Prijímajúca vysoká škola (Receiving higher education institution):
.........................................................................................................................................................................................................
.........................................................................................................................................................................................................	
Týmto potvrdzujeme prijatie: Prihlášky na výmenné štúdium, návrhu Zmluvy o štúdiu a Výpisu výsledkov štúdia kandidáta.
(We hereby acknowledge receipt of the application, the proposed study agreement and the candidate’s transcript of records.)	
Uvedený študent je                                           
(The above-mentioned student is)                                

Podpis fakultného koordinátora:
(Faculty coordinator’s signature):

...................................................................................

Dátum (Date): ..........................................................................	je predbežne prijatý na štúdium
(provisionally accepted at our institution)
nie je prijatý na štúdium
(not accepted at our institution)

Podpis inštitucionálneho koordinátora:
(Higher education institution coordinator’s signature):

.............................................................................

Dátum (Date): .......................................................