| Academic year of planned exchange*
|
|
| Name of exchange programme*
|
|
| Family name*
|
|
| First name (s)*
|
|
| Date of birth* (dd.mm.yyyy)
|
|
| Place of birth*
|
|
| Country of birth*
|
|
| Gender*
|
|
| Type of personal document*
|
passport
ID card
|
| Number of personal document*
|
|
| Nationality*
|
|
| Permanent address *
|
|
| Postcode and city *
|
|
| Country*
|
|
Postal address (if different)
|
|
| Postcode and city
|
|
| Country
|
|
| Postal address is valid until (dd.mm.yyyy)
|
|
| Telephone*
|
|
| E-mail*
|
|