Application Form For Czech Preparatory Course

Fill in in Latin alphabet.

Course programme

First Name:

Family 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?

from

Are you interested in the dormitory?

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.

Security Code (pay attention to letter case)