Ukrainian Summer School_Application Form 2018
Student Information:
First Name: *
Your answer
Family Name: *
Your answer
Birthdate : *
Mailing address:
Street and home number: *
Your answer
City: *
Your answer
Your answer
Postal Code/Zip: *
Your answer
Country: *
Your answer
Nationality: *
Your answer
Telephone: *
Your answer
Email: *
Your answer
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 answer
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)
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? *
(Choose one in each category)
No proficiency
Program details (dates, cost etc.)
Which session do you choose? *
for session A participants arrival dates are JUNE 16-17, for session B - JULY 7-8. Please plan your arrival between 9 a.m. and 6 p.m. *
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:
Your answer
Program provides one lesson of private tutoring, but would you like to have extra one? *
Would you like to take course for credit? *
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 Summer Program in Ukraine: *
Your answer
How did you learn about our Summer 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
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