POLITECHNIKA WARSZAWSKA – CENTRUM WSPÓŁPRACY MIĘDZYNARODOWEJ UCZELNIANA AGENCJA PROGRAMÓW EDUKACYJNYCH
WARSAW UNIVERSITY OF TECHNOLOGY - CENTRE FOR INTERNATIONAL
COOPERATION, EUROPEAN EDUCATIONAL PROGRAMMES
ul. Noakowskiego 18/20, 00-668 Warszawa, POLAND
tel. +(48 22) 234 74 04; fax: +(48 22) 629 80 09; e-mail: djasinska@cwm.pw.edu.pl

ERASMUS+ PROGRAMME
STUDENT APPLICATION FORM FOR TRAINEESHIP
ACADEMIC YEAR 2015/2016	Photo	

Please fill in by machine!

Personal Information
Last name:		First name:		
Date and place of birth:		Marital status:		
Citizenship:		Gender (F or M) :		

Permanent address	
Street:		Postal code & city:		
c/o, apt. no. :		Phone no.:		
Country:		E-mail:		

Term address	
Here I can be reached between                                and	
Street:		Postal code & city:		
c/o, apt. no:		Phone no.:		
Country:		E-mail:		

Person to contact in an emergency	
Name:		Relation:		
Street:		Country:		
Postal code:		Phone no.:		
City:		E-mail:		

Previous practical training of relevance – kind of work:	from – to:	Name of Company:	

			
Previous stays abroad under LLP Erasmus (studies and/or traineeship): 	Length of stay (in months):	The cycle of studies:	

			

Field of studies:
Present University:	Faculty:	The cycle of studies: 
…………….	

		The number of years required for this cycle of studies: …………….
	
		Completed years at the time of traineeship: ……………………

Computer skills:
Programme:	Good	Fair	Weak	Type of training:	

					

Language skills:
Language	Native	Fluent 	Good	Fair	Weak	Type of language training:	

							

Desired practical training and preferred sectors of activity:	

	
First possible starting date (not later than 1st July 2015):
	Duration of training – minimum 2 full months 	

Host country in order of preference:	Any other relevant information:	
1. 
2.
3.
4.

I agree and assure that the information given in this application is correct and can be circulated to companies.

Date: ..........................                                                       Signature: ................................................