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Ukrainian Summer School Application Form 2017
Student Information:
First Name:
Family Name:
Gender:
Birthdate :
(day/month/year)
MM
/
DD
/
YYYY
Mailing address:
Street and home number:
City:
State/Province/Territory:
Postal Code/Zip:
Country:
Nationality:
Telephone:
Email:
Give the names and addresses/phones/emails of relatives or friends, who may be contacted in case of an emergency:
In your home country and in Ukraine:
Your occupation and educational background:
If you're currently a student, what school do you attend?
(Name and address of your school, year you are in now)
What languages other then English do you know?
Do you have any previous experience in learning Ukrainian?
If possible please write which materials you used.
What is your proficiency level in Ukrainian?
(Choose one in each category)
No proficiency
Beginner
Intermediate
Advanced
Superior
Speaking
Writing
Reading 
Program details (dates, cost etc.)
Which session do you choose?
for session A participants arrival dates are JUNE 17-18, for session B - JULY 8-9. Please plan your arrival between 9 a.m. and 6 p.m. *http://studyukrainian.org.ua/php_uploads/data/articles/ArticleFiles_530_%F8%EA%EE%EB%E0_%EA%E0%F0%EF%E0%F2%E8.pdf
Required
Required
Do you or member of your family have experience in participating any program at School of Ukrainian language and culture?
(please write the name, year and program)
Are you a sponsored or scholarship student?
If yes, who is your sponsor/scholarship provider:
Program provides one lesson of private tutoring, but would you like to have extra one?
Required
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)
Write a paragraph to describe your interest in the Summer Program in Ukraine:
How did you learn about our Summer Program?
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.)
Required
Submit
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