Republic of Croatia - Ministry of Science and Education Agency for Mobility and EU Programmes

PRIJAVA ZA STIPENDIJU
APPLICATION FOR A SCHOLARSHIP

za akademsku godinu 2021. / 2022.

for the academic year 2021 / 2022

Spol / Gender

Sadašnja adresa / Present address

Stalna adresa / Permanent address

STUDIJSKI PLAN / STUDY PLAN

Ustanove u inozemstvu gdje želite studirati/istraživati
Institutions where you wish to pursue your studies or undertake research work

Trajanje studija u inozemstvu
Duration of planned study stay

do
to
Imate li mentora na matičnoj instituciji? (samo za studente poslijediplomskog/doktorskog studija i istraživačkih stipendija)
Do you have a supervisor at your home institution? (for post doctorate and research students only)

  

Imate li ostvaren kontakt s nekom ustanovom / znanstvenikom u inozemstvu? (samo za studente poslijediplomskog/doktorskog studija i istraživačkih stipendija)
Have you been in contact with any institution or professor in host country? (for post doctorate and research students only)
(Please indicate)

  

Jeste li prihvaćeni od strane jednog od stranih sveučilišta ili profesora (priložite pozivno pismo sa ispisanom verzijom prijavnice)?
Have you been accepted by any university or professor in a host country?
(Indicate and enclose a letter of acceptance with hard copy of this form)

ŠKOLOVANJE / CURRENT AND PREVIOUS EDUCATION

Kronološki popis svih škola i fakulteta koje ste pohađali počevši od sadašnjeg
List all colleges and universities you have attended in chronological order, starting with your current enrollment.
Naziv i mjesto ustanove
Name and Place of Institution
Studijska grupa
Major
Broj godina
No. of Years
Datum diplomiranja
Date of Graduation
Diploma
Degree
Materinski jezik(ci)
Mother tongue(s)
Drugi jezik(ci) / Other language(s)
Samoprocjena Europska razina / Self-assessment European level
Jezik / Language Razumijevanje / Understanding Govor / Speaking Pisanje / Writing
  Slušanje / Listening  Čitanje / Reading Govorna interakcija/Spoken interaction  Govorna produkcija/Spoken production  
Potpisano od strane podnositelja zahtjeva
To be signed by the applicant
 
Ja, dolje potpisani/a, izjavljujem da su svi navedeni podaci u ovom zahtjevu potpuni i točni. Svjestan/Svjesna sam da davanje netočnih odgovora na bilo koje od gore navedenih pitanja može dovesti do odbijanja mog zahtjeva.
I, the undersigned, declare that all of the above information in this application form is complete and accurate to the best of my knowledge. I am aware that giving incorrect answers to any of the above questions may lead to the cancellation of my application.
Nakon ispunjavanja ovog obrasca, bit će vam prikazan ispunjen obrazac u pdf formatu. Ispišite ga i spremite. Isprintan i potpisan on-line prijavni obrazac zajedno s ostalom potrebnom prijavnom dokumentacijom treba poslati poštom na adresu Agencije za mobilnost i programe Europske unije na adresu navedenu u natječaju.
After submitting this form, you will be presented with pdf version of this form. Print it and save it. Printed and signed on-line application form together with the required application materials should be sent by post to the Agency for Mobility and EU Programmes to the address stated in the Call for applications.
Odjel za visoko obrazovanje koji djeluje pri Agenciji za mobilnost i programe Europske unije obrađuje Vaše navedene osobne podatke u svrhu prijave na natječaj. Više o obradi osobnih podataka možete pročitati u Općoj obavijesti o obradi osobnih podataka dostupnoj ovdje.

The Department for Higher Education at the Agency for Mobility and EU Programmes is processing your personal dana for the purpose of evaluating your application for the scholarship. More detailed information on processing of your personal information is available in the General Notice on Processing of Personal Data published here.
Datum / Date Potpis / Signature
19.10.2020.