REPUBLIKA HRVATSKA REPUBLIC OF CROATIA MINISTARSTVO ZNANOSTI, OBRAZOVANJA I SPORTA MINISTRY OF SCIENCE, EDUCATION AND SPORTS

PRIJAVA ZA STIPENDIJU U HRVATSKOJ

APPLICATION FOR A SCHOLARSHIP IN CROATIA za akademsku god.
for the academic year

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Zemlja podrijetla / Country of origin Prezime / Surname Ime / First name Datum i mjesto roenja / Date and place of birth
Dravljanstvo / Citizenship Spol / Gender Broj putovnice / Passport number Sadanja adresa / Present address Stalna adresa / Permanent address Telefon, mobitel / Telephone, Cellular Phone E - pota / E-mail Muko / Male ensko / Female

MINISTARSTVO ZNANOSTI, OBRAZOVANJA I SPORTA / MINISTRY OF SCIENCE, EDUCATION AND SPORTS

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STUDIJSKI PLAN / STUDY PLAN

A.
Ustanove u Hrvatskoj gdje elite studirati/istraivati / Institutions where you wish to pursue your studies or undertake research work

B. C.

Naziv studija / Name of a study

KOLOVANJE / CURRENT AND PREVIOUS EDUCATION

Kronoloki popis svih kola i fakulteta koje ste pohaali poevi od sadanjeg / 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

Znanje stranog jezika / Language Skills

nita / none- A loe / poor- B slabo / fair- C dobro / good- D teno / fluent- E
itanje / Reading Govor / Speaking Pisanje / Writing

Jezik / Language Hrvatski / Croatian Engleski / English Ostalo / Other Ostalo / Other

MINISTARSTVO ZNANOSTI, OBRAZOVANJA I SPORTA / MINISTRY OF SCIENCE, EDUCATION AND SPORTS

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Ja, dolje potpisana/i, izjavljujem da su svi navedeni podaci u ovom zahtjevu potpuni i toni. Svjesna/Svj estan sam da davanje netonih odgovora na bilo koje od navedenih pitanja moe dovesti do odbijanja mog zahtjeva. / I, the undersigned, declare that all of the above information in this application forms 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.

Mjesto / Place

Datum / Date

Potpis / Signature

Potrebna dokumentacija / Documents to be submitted: o o o o Printed version of the Application form One (1) identity card photo, affixed on the application form A photocopy of passport Curriculum Vitae (in Europass format) http://europass.cedefop.europa.eu/europass/home/hornav/Downloads/EuropassCV/CVTemplate.csp o o o o Letter of interest Copy of the last acquired Certificate or Diploma A language certificate of the language(s) that the candidate declares that he/she speaks Medical certificate of satisfactory health condition

MINISTARSTVO ZNANOSTI, OBRAZOVANJA I SPORTA / MINISTRY OF SCIENCE, EDUCATION AND SPORTS

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