Exchange programs application form

Application form for entry as an exchange student:

Personal details:
First name *:
Surname *:
Gender *:
Date of birth *:
Place of birth *:
Nationality *:
Passport number *:
Date of issue *:
Valid until *:
Place of issue *:
Passport copy (max size 2 MB) *:
Profile photo (max size 2 MB) *:
Permanent address:
Number and street *:
City *:
Postcode *:
Country *:
Telephone numbers *:

E-mail address *:
Academic information:
Home university:


Home department:
Study programme *:
Erasmus+ type *:
Departmental Erasmus coordinator (at your home university) contact info:
Full name *:
Phone number *:
E-mail address *:
Additional information:
Program:
Language competence in english *:
Period of study *:	from: to:

Accommodation:	(Select if you like to apply for accommodation at Panevėžio kolegija/State Higher Education Institution)
Motivation:
Person to contact in case of emergency:
Relation *:
Full name *:
Phone number *:
E-mail *:
Agreements:
I confirm that all information in this application are to the best of my knowledge. *
I agree to the processing of my personal data contained in the form and its appendices for the purpose of assessing compliance with the Enrolment Regulations, the preparation and conclusion of the Contract on education with the Panevėžys University of Applied Science, and preparation of documents for obtaining a visa / residence permit. I certify that the personal data submitted by me is accurate and I undertake to inform immediately about the changes in the data. *
I agree that the specified e-mail address and phone will be used for communication until the Contract on education is concluded. *
* Marked fields must be filled.

Exchange programs application form

Application form for entry as an exchange student:

Potential employers: