Ukrainian Spring Application Form
Student information:
First Name: *
Your answer
Family Name: *
Your answer
Gender: *
Birthdate: *
MM
/
DD
/
YYYY
Phone number: *
Your answer
Email: *
Your answer
Nationality: *
Your answer
Mailing Address:
Street and house number: *
Your answer
City: *
Your answer
State/Province/Territory: *
Your answer
Postal Code/Zip: *
Your answer
Country: *
Your answer
Give the names and addresses/phones of relatives or friends, who may be contacted in case of an emergency: *
In your home country and in Ukraine:
Your answer
Occupation and educational background:
If you're currently a student, what School/ University do you attend? *
(Name and address of your school, year you are in now)
Your answer
What languages other then English do you know?
Your answer
Do you have any previous experience in learning Ukrainian? *
If possible please write which materials you used.
Your answer
What is your proficiency level in Ukrainian? *
No proficiency
Beginner
Intermediate
Advanced
Superior
Speaking
Writing
Reading
Program details (dates, cost etc.)
Which session do you choose? *
Required
Required
Do you or member of your family have experience in participating any program at School of Ukrainian language and culture?
(Those who are will receive a 10% discount for tuition)
Would you like to take course for credit? *
Required
Write your University registrar's office address:
(For those, who needs credits or where you would like your transcript to be sent)
Your answer
Write a paragraph to describe your interest in the Spring Program in Ukraine: *
Your answer
How did you learn about our Spring Program? *
Your answer
State of health: *
(please indicate any special needs related to health concerns, i.e., medical conditions and/or medication, wheelchair, crutches, diabetic, allergies: food, medical or enviromental, etc.)
Your answer
*
Required
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