Application Form For Czech Preparatory Course – English programme

Fill in in Latin alphabet.

Course programme One Semester – english programme
Family Name:
First Name:
Date of Birth:
Place of Birth:
Citizenship:
Residential Address:
Post code:
Contact Address (if only is not the same to Residential Address):
Passport Number:
Passport Validity:
Phone Number:
E-mail:
Your parents' e-mail address:
Have you been to Czech Republic? NoYes
from ... to
Are you interested in the dormitory? NoYes

Attach the copy of your travel passport – maximum size of the attached dokument: 500 kB

Attach the copy of your latest school-leaving certificate – maximum size of the attached dokument: 500 kB




I confirm that all the information provided is full and correct. I am aware that the provision of false data can be the reason to be refused in acceptation to the course.

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