International Department
South Ural State Agrarian University
Chelyabinsk
Russian Federation
tel: +7 351 266-65-12
E-mail: mo@[Link]
[Link]
APPLICATION FORM
Please fill in all the sections. Enclose a set of supporting documents with this application.
1. Personal Details:
Family name (as shown on the passport):____________________________________________
Given Name(s) (as shown on the passport):__________________________________________
Nationality:____________________________________________________________________
Date of birth (dd/mm/yyyy): _______________________ Gender (M/F):____________________
Place of birth (country, city):_______________________________________________________
Passport Number:_______________________________________________________________
Date of Issue (dd/mm/yyyy): ________________ Expiry Date (dd/mm/yyyy):________________
2. Applicant’s Contact Details:
Home address:
Number & street: _______________________________________________________________
City/town/village name: __________________________________________________________
State/ Region: _________________________________________________________________
Post/zip code: ____________________________ Country: _____________________________
Phone: _________________________________ Mobile:______________________________
E-mail:_______________________________________________________________________
Mailing address (if differs from above): ______________________________________________
3. A way to return the submitted documents in case of non enrollment to training:
_____________________________________________________________________________
4. A level of education and document of the established pattern: ______________________
_____________________________________________________________________________
5. Foreign language proficiency: _________________________________________________
6. The necessity in the hostel accommodation:______________________________________
7. Arrival and Departure Information:
Date of arrival to Russia: ________________________________________________________
Date of departure from Russia:____________________________________________________
Place of visa issue (country, city):__________________________________________________
8. Choose one of the two programs (tick one):
□ □
Russian as a foreign language Russian as a foreign language
Informatics Chemistry
Mathematics Biology
Physics Physics
APPLICANT’S SIGNATURE ______________________________________________
DATE________________________________________________________________
