Language
English (US)
The Kosciuszko Foundation Summer Study Abroad
Application Form.
Scholarship category
I am applying for:
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Tomaszkiewicz-Florio Scholarship
Wisconsin Study in Poland Scholarship
Enrollment details
Summer Session Programs (choose one)
Session A, arrival Sunday, July 3 - return Sunday, July 31
Session C, arrival Sunday, July 3 - return Sunday, July 24
Session D, arrival Sunday, July 24 - return Sunday, August 14
Accommodation
Room type:
Shared room (no extra charge)
Single room (extra charge)
Lectures
Please make sure that the courses you choose do not overlap and are taught during your stay in Kraków. The number of courses chosen does not affect the price of the entire program
Which course(s) would you like to attend?
9:00 a.m.-12:45 p.m. Polish Language (intensive) – taught on A, C, and D programs
2:30 p.m. - 4:15 p.m Polish Grammar, session I (ENG); July 5th-22nd, 30 hours
2:30 p.m. - 4:15 p.m. Literatura i kultura polska XX i XXI wieku (POL); July 5th-22nd, 30 hours
2:30 p.m. - 4:15 p.m. Literatura i kultura polska XX i XXI wieku (POL); August 1st-9th, 15 hours (PLEASE NOTE:on August 9th classes will be held untl 5:00 p.m.)
4:30 p.m. - 6:15 p.m.Contemporary Poland and Her Society (ENG); July 5th-22nd, 30 hours
4:30 p.m. - 6:15 p.m. Polish Grammar, session II (ENG); July 25th-August 3rd, 15 hours (PLEASE NOTE: from July 25th to 29th classes will be held onsite, from August 1st to 3rd – online)
Personal Information
Last Name
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First Name
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Middle Name
Maiden Name
Gender
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Male
Female
Date of Birth (mm/dd/yyyy)
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Month
-
Day
Year
Date
Place of Birth (City, Country)
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Marital Status
Single
Married
Passport Information
U.S. Passport number
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U.S. Passport Date of Expiration
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Month
-
Day
Year
Polish Passport number, if applicable
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Polish Passport Date of Expiration
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Month
-
Day
Year
Naturalization Certificate #
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Alien Registration # (Green card)
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Date of Entry to the US
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Month
-
Day
Year
Contact Information
Email Address
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Phone Number
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Country Code
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Area Code
Phone Number
Address (street/number/city/postal code)
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Emergency Contact Details
First Name
Last Name
Emergency Contact Number
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Country Code
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Area Code
Phone Number
Emergency Contact Email
example@example.com
Relationship to Applicant
Emergency Contact Details in Poland
First Name
Last Name
Emergency Contact Number in Poland
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Country Code
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Area Code
Phone Number
Emergency Contact Email in Poland
example@example.com
Relationship to Applicant
Purpose/Motivation
Have you ever been abroad?
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YES
NO
If yes, list countries and purpose of visits.
Why do you want to study Polish?
Have you taken any courses in the Polish language? If so, list previous courses taken, level, text books, etc. ?
List other foreign languages you know or have studied.
How did you hear about the KF Summer Study Programs?
Rate your knowledge of the Polish language
Oral
none
poor
fair
very good
excellent
Written
none
poor
fair
very good
excellent
Education/Employment
Are you currently in school?
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YES
NO
If yes, list school name, address and current year of study (freshman, sophomore, junior, senior).
Major
*
Degree
*
Expected graduation
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Month
-
Day
Year
Date
Employer, if not in school
Enter employer name and address
Payments
Non refundable enrollment fee.
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Summer Study Enrollment fee
$
75.00
Total
$
0.00
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Agreements
I release to the Kosciuszko Foundation the right to use my name and other information contained in this application for Foundation's publications, reports and/or press releases in the scope necessary for the selection process, award announcements, and administration of the Summer Study Program.
*
I consent
I do NOT consent
I certify that the information I provided in the application is true and complete.
*
I consent
Signature - to append a signature please type in your full name
Date
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