SUMMER SCHOOL 2019 APPLICATIONFORM

SUMMER SCHOOL 2019 APPLICATION FORM

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PERSONAL DETAILS

Please affix photograph.

LAST NAME

MIDDLE NAME (if any)

FIRST NAME(S)

ENROLMENT NO.

CURRENT

ADDRESS:

STREET

NR

ZIP CODE

CITY

PERMANENT

ADDRESS:

STREET

NR

PHONE

ZIP CODE

CITY

E-MAIL

SEX: Please select

one

MOBILE

DD - MMMM - YYYY

BIRTH DATE

PLACE OF BIRTH

NATIONALITY

Select degree program

Select type of degree

DEGREE PROGRAM

Please select one

UNIVERSITY CAMPUS PRESENTLY ATTENDING (DELETE)

Select

CURRENT SEMESTER

Select / 10

YEARS OF ENGLISH (SCHOOL) /

SEMESTERS OF ENGLISH (UNIV.)

EMERGENCY CONTACT PERSON for any unexpected situations (e.g.

sudden and serious illness, accident, non-arrival on expected flight,

…):

I allow the coordinators of the Summer School Program to contact the

person(s) mentioned below in all of the matters described above and similar situations which require immediate decisions and/or solutions. I waive my right to confidentiality for this type of communications.

LAST NAME

FIRST NAME(S)

STREET

NR

PHONE

ZIP CODE

CITY

E-MAIL

IMPORTANT NOTICE: A deposit of € 750 will be due on acceptance of my application. It will not be reimbursed if I do not participate in the program (unless the place reserved for me is taken over by another student). Higher costs may arise if I cancel my place after 15 July without a very strong reason (which must be proven by appropriate documents, e.g. medical certificates). I may have to pay an extra fee of up to € 750 (as determined by the program coordinators) to cover the financial deficits resulting from an improperly excused cancellation at very short notice.

I am aware that I will need to apply for the relevant visa in time if necessary. (The information about the procedures will be provided by Coastal Carolina University.) I will

take part in all of the prescribed events and activities before and during the program Late arrivals and early departures are not acceptable. Failure to comply with these rules may result in exclusion from the program without any reimbursement of fees or deposits.

I ACCEPT THE ABOVE CONDITIONS AND

I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND ACCURATE .

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D - MMMM - YYYY

STUDENT’S SIGNATURE DATE

LETTER OF ENDORSEMENT (SENDING INSTITUTION):

be completed by the program coordinators

I endorse this application for participation in the 2019 Summer School Program.

The above person is a student of our university and has been chosen as a

participant.