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Ukrainian Summer School Application Form 2017
Street and home number:
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)
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. *
A - 2 weeks $1 370 June 19 - 30 (including Carpathian session*)
A - 3 weeks $1 830 June 19 - July 7
A - 4 weeks $2 340 June 19 - July 14
A - 5 weeks $2 900 June 19 - July 21
A - 6 weeks $3 310 June 19 - July 28
B - 2 weeks $1 370 July 10 - July 21
B - 3 weeks $1 830 July 10 - July 28
Summer program for Plast $1 830 July 10 - July 28
Accommodation in Lviv:
University housing double room
University housing single room (extra $75/week)
Homestay (extra $75/week)
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?
Yes (extra $25 per week)
Would you like to take course for credit?
Yes (extra $75 per week)
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.)
I hereby certify that my health allows me to participate in the Summer School program. I am responsible for my own insurance.
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