Admission application Name ________________________________________________________________________ Surnames Title of course: Date of reception (to be filled in by FPC) _________________________________ APPLICATION FORM (Please fill in the form by typewriter or by hand in block capitals to avoid errors) TITLE OF COURSE: _________________________________________________ PERSONAL DETAILS 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 ___ ACADEMIC DETAILS STUDIES............................................................................................................................ OTHER INFORMATION 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........................... PROFESSIONAL DETAILS Employment details (please mark the appropriate box with a cross) PUBLIC SECTOR ___ PRIVATE SECTOR ___ NOT WORKING ___ UNEMPLOYED ___ NAME OF COMPANY....................................................................TAX NUMBER............................................... ADDRESS................................................................................................ CITY.....................................................................POSTCODE...................... COMPANY TELEPHONE.............................................FAX...................................... DEPARTMENT.................................................POSITION................................... SECTOR THAT THE COMPANY WORKS IN........................................................................ How did you find out about this course? ___ Previous students ___ Press __ Others ___ Magazines : ___ General 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 to: Our address is: Fundació Politècnica de Catalunya Monica Linares c/Colom, 2 08222 Terrassa (Barcelona) Spain