Admission application
Name
________________________________________________________________________
Surnames
Title of course:
Date of reception (to be filled in by FPC)
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APPLICATION FORM |
(Please fill in the form by typewriter or by hand in block capitals to avoid errors)
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TITLE OF COURSE : ____________________________________________________________________________________________________________________ |
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PERSONAL DETAILS |
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NAME AND SURNAMES..................................................................................................................... Passport number............................... .NATIONALITY........................ DATE OF BIRTH............................... PLACE OF BIRTH ........................................ PRESENT ADDRESS(street/number/apartment).................................................................................................................. TOWN OR CITY......................................................................POSTCODE.................................... TELEPHONE...................................................................FAX............................................................... USUAL ADDRESS ..................................................................................................................... TOWN OR CITY......................................................................POSTCODE.................................... TELEPHONE...................................................................FAX............................................................... E-mail.................................................................................................................................................. Authorisation of future use of data (mark the appropriate box with a cross) For fellow students ___ For professional interests ___ For general information ___ |
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ACADEMIC DETAILS |
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STUDIES............................................................................................................................
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OTHER INFORMATION |
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DO YOU HAVE KNOWLEDGE OF COMPUTERS? ___ YES ___ NO (please give details) ............................................................................................................................................................................ ............................................................................................................................................................................ KNOWLEDGE OF LANGUAGES (please provide details of level; VG: very good, G: good, F; fair) ENGLISH writing.......................…reading........................ speaking........................... FRENCH: writing.......................…reading........................ speaking........................... OTHERS: writing.......................... reading........................ speaking........................... |
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PROFESSIONAL DETAILS |
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Employment details (please mark the appropriate box with a cross) PUBLIC SECTOR ___ PRIVATE SECTOR ___ NOT WORKING ___ UNEMPLOYED ___ NAME OF COMPANY....................................................................TAX NUMBER............................................... ADDRESS.................................................................................................................................................. TOWN OR CITY.........................................................................POSTCODE.......................................... COMPANY TELEPHONE.............................................FAX................................................................. DEPARTMENT................................................................POSITION........................................................... SECTOR THAT THE COMPANY WORKS IN................................................................................................................................ |
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How did you find out about this course? |
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___ Previous students ___ Press __ El País __ La Vanguardia __ El Periódico __ Others (please give details): ___ Magazines (please give details): ___ General course leaflet ___ Specific course leaflet ___ Internet ___ Other: |
NOTE: Afterwards you will need to send us by mail a photocopy of your identity card or passport, and a copy of the receipt of the bank transfer.
Our address is:
Fundació Politècnica de Catalunya
Monica Linares
C/ Colom 2
08222 Terrassa (Barcelona)
Spain