Application Form for Master (M.Sc.

, 2nd cycle)
Studies in English
(Please complete this form in electronic way, then print it and sign with a pen,
than scan and send by mail : adebska@pk.edu.pl)

1. Personal Data
First Name Muhammad ...............................................................................
Middle Name(s).Asif ................................................................................................
Surname...Javed
GenderMALE
Marital Status.Married...........................................................................................
Date of Birth (dd/mm/yyyy)08/03/1987.
Date of Birth (city, country)Gojra,Pakistan.
Citizenship/s .Pakistani..
Nationality...Pakistani
Roots *
Polish
Non-Polish
Passport Number CS8670992... Valid till
Fathers NameMahmood Ahmed...Fathers SurnameJaved
Mothers NameRazia.Mothers Maiden Surname..Bano.

2. Contact:
E-mail:lee.chan215@gmail.com............................!!!
Mobile (with direction on country):. 00923456257363....!!!

Permament address in applicants

Address for Correspondence:

country of orgin
Street...Chak No363/J.B,..

(with code of country, city)

Building nr/apartment n. Behmani

Street

wala..

Building nr/apartment nr ......

CityGojra

City

Country Pakistan

Country

Postcode36120

Postcode

Telephone nr.

* Please tick appropriate box

2. Study at Cracow University of Technology

DirrectionMSc in MECHANICS AND MACHINE DESIGN
FacultyMechanical Engineering
Date start of studies:February
3. Previous Education

a). Center/school, where candidate prepare for aboard study (not obligatory).
Name
Place (city , country).
Duration (from)(till)

b). Name and address of University where you recived Bachelor diploma
........................University of Engineering and Technology Taxila,Pakistan...................
........................................................................................................................................
Degree Title:....................BSc in Mechanical Engineering.............................................
Diploma Number: ..........................................................................................................
Name of Diploma: ...
Date (dd/mm/yyyy) and place (city, country) of issue: ..(25/08/2010 )(Taxila,Pakistan).
Duration (from)16/09/2006(till)25/08/2010..

c). Name and address of High School : .............Allama IqbalScience Collage Gojra...
........................................................................................................................................
Degree Title:..........................Pre Engineering..........................................................
Diploma Number: ...........................................................................................................
Name of Diploma: .........
Date (dd/mm/yyyy) and place (city, country) of issue: ..06/06/2006(Faisalabad,Pak.)
Duration (from) 2004(till)2006

* Please tick appropriate box

d). Languages Knowledge:

Native LanguageUrdu....................
Official Language...English
Foreign languages and their knowledge level*:
LANGUAGES
KNOWLEDGE LEVEL

Basic

Medium

Advanced

Expert

English..

....Arabic.

4. Motivations (Please explain why you chose Cracow University of Technology and why
you wish to take the respective programme of study. How it relates to your career/academic
objectives?)
.

Attachment

5. I would like to apply for a place at CUT dormitory*

Yes
No
6. Statement *
I declare that I have validatory CARD OF POLISH

Yes

No

Yes

No

I declare that Im citizen of country European

Uniion UE, European Free Trade Association
European Economic Area or Swiss Confoederation

* Please tick appropriate box

Futhermore,
I declare that I havnt Polish citizenship
I have not received permission to settle in Poland
I have not status of refugee status in Poland
I have not temporary protection in Poland
Im not migrant worker , who is citizenchip of member European Union, Swiss
Confederation or a Member State of the European Free Trade Association (EFTA), the
Agreement on the European Economic Area nor a member of the family of that worker
residing in the territory of Poland.
I have not been granted permission to stay long-term resident of the European Communities
in Poland
I have not been granted a residence permit for a fixed period on the territory of the Republic
of Poland in relation to the circumstance referred to in Article. 53 section 1 point. 7,13,14 Act
of 13 June 2003 on foreigners (Journal of Laws of 2006 No. 128, item. 1175, as amended.
Amended)
I have not been granted subsidiary protection in Poland

..............................................................
Hand-written signature of applicant

.............10/06/2010.(Gojra).......
Date (dd/mm/year) and place

7. Source of information about the Cracow University of Technology.

Select the correct answear/s
a) Educational fairs
b) Study in Poland
c) Study in Krakow
d) friends recommendation
e) leaflet
f) Web portal
g) Exchange/freemover at CUT (etc.)
h) othes..

8. Other applications:
(Please state which other universities you have applied to)

..

.
DATA CONTAINED IN THE APPLICATION FORM ARE TRUE
I agree to the University processing personal data contained in this form, or other data which the
University may obtain from me or other sources. I agree to the processing of such data for any
purpose connected with my studies or my heath, welfare and safety, or for any other legitimate reason.
(Ustawa z dnia 29.08.97 O Ochronie Danych Osobowych, Dz. Ust. nr 133, poz. 883)

Hand-written signature of applicant

* Please tick appropriate box

.............10/06/2010.(Gojra).......
Date (dd/mm/year) and place
4