Croaticum - Application form in English

REPUBLIC OF CROATIA
MINISTRY OF FOREIGN AFFAIRS AND EUROPEAN INTEGRATION

APPLICATION FORM
for attending the Croatian language course in the academic year 2011/12

1. Personal information:

1.1. First name………………………………………………………………………………………………..

1.2. Family name………..……………………………………………………………………………………

1.3. Date and place of birth.. …………………………………………………………………………………

1.4. State of birth …………………………………………… Citizenship……...……………………………

1.5. Gender M F

1.6. Passport No… ……………………………………………………………………………………………

1.7. Information about previous education (Please circle):

a) Secondary school
b) Junior college
c) College

2. Permanent residence:

2.1. Street ………………………………………………………………………………………………………

2.2. House No.…………………….

2.3. Place ……………………………………..………………………………………………………………..

2.4. Postal code ………………………………………………………………………………………………..

2.5. State ...…………………………………………………………………………………………………….

2.6. Telephone………………………………………………………………………………………………….

2.7. E-mail address: …………………………………………………………………………………………….

3. Reason for applying: …………………………………………………………………………………….. ……………………………………………………………………………………………………………...……………………………………………………………………………………………………………...


4. Number of semesters you wish to attend (select one option)

1) one semester

a) winter semester (October 3, 2011 – January 27, 2012)
b) summer semester (March 5, 2012 - June 15, 2012)

2) two semesters (October 3, 2011 - June 15, 2012)

5. Application for accommodation in a student dormitory* (only for attendants up to 30 years old)

5.1. I want to use an accommodation in a student dormitory

1) YES

(Please circle)

2) NO

*the monthly cost at the student dormitory is between 200 and 600 HRK

5.2. Address in the Republic of Croatia for the attendants who ARE NOT STAYING in a student dormitory

…………………………………………………………………………………………………………

6. Questions for the applicants who attended the course before

6.1. How many semesters have you finished?

1 2 3 4 (Please circle)

6.2. When did you attend the course?

…………………………………..

6.3. Who paid the tuition fee?

…………………………………..







Date…………………………………….. Signature………………………………




ENCLOSURES:



1. A filled out application form

2. A photocopy of the passport (of a valid travel document)

3. A proof of Croatian origin in writing (any official document showing the status of the candidate, or one of his parents or ancestors, in this regard)

4. A brief CV





Note: Fill out the application form on a computer or a typewriter. Incomplete, incorrect and late applications shall not be considered or admitted.

More information can be obtained on the telephone number +385 1 4896 316, 4896 320, workdays from 9.00 to 16.00, or by e-mail address: croaticum@mvpei.hr.
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Dra. Adriana Smajic – Abogada y Traductora pública de idioma croata – Attorney at Law – Odvjetnica – Abogado croata – Traductor croata http://www.adrianasmajic.blogspot.com/  adriana.smajic@gmail.com

Joza Vrljicak – Master in Economics (Concordia U, Montreal) joza.vrljicak@gmail.com

(+54-11) 4811-8706 (+54-911) 6564-9585 (+54-911) 5112-0000