FACHHOCHSCHULE POTSDAM
UNIVERSITY OF APPLIED SCIENCES 	 
International Office             
Pappelallee 8-9									   
Germany-14467 Potsdam

Head/Programme-Coordinator: Dr. Uta Kotulla
TEL       +49.331.580.2010
Fax        +49.331.580.2019
e-mail:  kotulla@fh-potsdam.de

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APPLICATION Form *
INCOMING STUDENTS from______________________________________
Name of University/Institution/				
Country

FIELD OF STUDY

*Send back this application form to Fachhochschule Potsdam 

PERSONAL DATA

Name

Date of birth( day/month/year)

male/female

Nationality				

Current address

Passport number

Tel:   (country code )                 ( City code)                     (Home No)

e-mail

Person to be contacted in case of emergency

Name/Address

Tel:
email

Contact person at the home Institution/Coordinator

Name

Tel:						Fax:
e-mail

EDUCATION COMPLETED PRIOR TO THIS APPLICATION

Home Institution

Degree Course

Year attended

Specialization

LANGUAGE COMPETENCE

 German  (level) 	< elementary>* not accepted for Design !!!!		
			 intermediate		advanced
(Important:  It is recommended to have German Language competence –
We don’t held courses in English- only in German  !!!!)
Please attach a Certificate of your  language proficiency German
(on level A2 or  TestAF 3- Requirement of Department of .Design )
	
Spanish (level)    	 elementary		intermediate		advanced

Italian    (level)    	 elementary		intermediate		advanced

English  (level)             elementary		intermediate		advanced

other Language qualifications:

  

Programs at the host Institution

major subject

elementary		intermediate		advanced
one year  (from – to )

semester( from -  to)

Exchange based on

		Bilateral Agreement:			other:

Accommodation 
Please choose the option desired

  I wish finding accommodation
     by STUDENTENWERK POTSDAM

1. Please apply ( latest 15 th of July ) online under
http://www.studentenwerk-potsdam.de/formulare/wohnheimantrag.html
You have to send that application by yourself( online) to Studentenwerk !!!

2. Please confirm me, that you have applied online*
•	I have applied online by Studentenwerk Potsdam on .........................(date)
*I need this information urgent for further co-ordination

  I find accommodation on my own

Further comments

Signature of exchange student:	           Date			Signature

Confirmation							Confirmation o f host Institution

Home Institution (Stamp and signature)		    

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