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Summer Business School
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First name:
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Your answer
Last name:
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Your answer
Gender
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Male
Female
Birthdate
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(month/day/year)
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DD
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YYYY
Mailing address:
Country:
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City:
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State/Province/Territory:
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Street and home number:
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Postal Code/Zip:
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Nationality:
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Your answer
Telephone:
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Email:
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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
State of health
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(Please indicate any special needs related to health concerns, i.e., medical conditions and / or medication, wheelchair, crutches, diabetic, allergies: food, medical or environmental, etc.)
Your answer
Your occupation and educational background:
If you're currently a student, what school do you attend?
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(Name and address of your school, year you are in now)
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Do you have prior travel experience?
If yes, please indicate where, how long and when?
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What languages other than English do you know?
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Would you like to take course for credit?
Yes
No
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Write your University registrar's office address
(For those who need credits or where you would like your Transcript to be sent)
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Write a paragraph to describe your interest in the Summer Business School:
*
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Accommodation in Lviv:
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University housing ( 2 persons per room )
University housing ( single room )
Homestay
Other:
How did you learn about our Summer Program?
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Your answer
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I hereby certify that my health allows me to participate in the Summer School programs. I am responsible for my own insurance
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