Received (for official use only) Date ………………… Signature ….……………

University of Rzeszów

35-959 Rzeszów

Al. Rejtana 16C

RECTOR

of the UNIVERSITY of RZESZÓW

I APPLY FOR ADMISSION TO:

FACULTY	Faculty of Economics
FIELD OF STUDY	Economics
LEVEL OF STUDIES (STUDIES, COURSES)
STUDY SYSTEM	LANGUAGE OF STUDIES
ON THE BASIS OF RULES FOR POLISH CITIZENS (in accordance with art. 43, sec. 2 of the act of 27 July 2005 .The Higher Education Act ) because*:
I was granted a permanent residence permit;
I have a refugee status granted in the Republic of Poland;
I was granted temporary protection on the territory of the Republic of Poland;
I am a migrant worker who is a citizen of a European Union member state, the Swiss Confederation or a member state of the European Free Trade Agreement (EFTA) - parties to the Agreement on the European Economic Area (or a member of their family residing on the territory of the Republic of Poland);
I was granted a residence permit of a long-term resident of the European Union on the territory of the Republic of Poland;
I was granted a temporary residence permit on the territory of the Republic of Poland in connection with the circumstances referred to in art. 127, art. 159 sec. 1 or art. 186 sec. 1 point 3 or 4 of the act of 12 December 2013 on foreigners (Journal of Laws, item 1650);
I was granted subsidiary protection on the territory of the Republic of Poland;
I am a citizen of a European Union Member State, a member state of the European Free Trade Agreement (EFTA) - parties to the Agreement on the European Economic Area or the Swiss Confederation (or I am a member of their family) with permanent residence.
ON THE BASIS OF RULES THAT APPLY TO POLISH CITIZENS (in accordance with art. 43 sec. 5 or 5a of the act of 27 July 2005. Higher Education Act) because*:
I am a citizen of a European Union member state, the Swiss Confederation or a member state of the European Free Trade Agreement (EFTA) - parties to the European Economic Area (or a member of their family) having financial means necessary to cover the cost of living during studies and I declare that I am not applying for admission to university on other bases than those that apply to the Polish citizen;
I am a holder of a valid Polish Charter and I declare that I am not applying for admission to university on other bases than those that apply to the Polish citizen.
ON THE BASIS OF OTHER RULES THAN THOSE THAT APPLY TO THE POLISH CITIZEN (in accordance with art.43. sec.3 and 4 of the act of 27 July 2005. Higher Education Act.) *:
I cover tuition fees;
as a scholarship holder of the Polish side;
without payment of tuition fees and scholarship benefits;
as a scholarship holder of the sending party without paying for tuition fees;
as a scholarship holder of the university.
ON OTHER BASES

Rzeszów, date Click here to enter the date	Legible signature of the candidate:,.........................................................................

PERSONAL QUESTIONNAIRE

Legal basis: Regulation of the Minister of Science and Higher Education of 16 September 2016 on documentation of the course

studies (Journal of Laws of 2016, item 1554, as amended)

PERSONAL DATA OF THE CANDIDATE

(consistent with the spelling in the passport)

SURNAMEClick here to enter text.	FIRST NAMES Click here to enter text.

MAIDEN NAME (FOR MARRIED WOMEN) Click here to enter text.

FATHER’S FIRST NAME: Click here to enter text. MOTHER’S FIRST NAME Click here to enter text.

DATE OF BIRTH Click here to enter the date PLACE OF BIRTH (MIEJSCOWOŚĆ/KRAJ): Click here to enter text.

CITIZENSHIP	Click here to enter text. COUNTRY OF PERMANENT RESIDENCE Click here to enter text.

COUNTRY OF ORIGIN*:

POLISH CHARTER HOLDER *No.: Click here to enter the date

DOCUMENTS CONFIRMING LEGALITY OF RESIDENCE ON THE TERRITORY OF THE REPUBLIC OF POLAND*:

Click here to enter text.	VALID THROUGH Click here to enter the date

Click here to enter text. VALID THROUGH	Click here to enter the date

TYPE OF AUTHORIZATION Click here to enter text.

ADDRESS OF PERMANENT RESIDENCE:

COUNTRY Click here to enter text.	POSTAL CODE Click here to enter text.	TOWN/CITY Click here to enter text.

STREET AND HOUSE NO.	Click here to enter text.

TELEPHONE NUMBER (WITH A DIALLING CODE)	Click here to enter text.

CORRESPONDENCE ADDRESS:

COUNTRY Click here to enter text.	POSTAL CODE Click here to enter text.	TOWN/CITY Click here to enter text.

STREET AND HOUSE NO. Click here to enter text.

CONTACT TELEPHONE NUMBER IN POLAND Click here to enter text.	E-MAIL Click here to enter text.

CANDIDATE’S EDUCATION*

Click here to enter text.

TOWN/CITY Click here to enter text.	COUNTRY Click here to enter text.

YEAR OF THE ISSUE OF THE SECONDARY SCHOOL CERTIFICATE Click here to enter the date

Click here to enter text.

TOWN/CITY Click here to enter text.	COUNTRY Click here to enter text.

YEAR OF GRADUATION Click here to enter the date	TITLE OBTAINED Click here to enter text.

Click here to enter text.

TOWN/CITY Click here to enter text.	COUNTRY Click here to enter text.

YEAR OF GRADUATION Click here to enter the date	TITLE OBTAINED Click here to enter text.

DECLARATIONS

I, the undersigned, declare that I do not have Polish citizenship in accordance with the act of 2 April 2009 on Polish citizenship (i.e., Journal of Laws of 2017, item 1462, as amended).

In the case of acquisition of Polish citizenship or the revealing of this heredity during my studies, I undertake to inform the university about this fact.

In the event of a change in the legal status of a foreigner on the territory of the Republic of Poland, including,

in particular, changes to documents confirming the legality of stay in Poland, I undertake to immediately inform the proper Dean's Office or Education Department about this fact.

I confirm the correctness of the data contained in the questionnaire by my own signature.

Rzeszów, date Click here to enter the date	..........................................................................

/Legible signature of the candidate/

I, the undersigned, declare that I have become acquainted with the Rector's Regulation on the rules of admission

and studies at the University of Rzeszów by foreigners and the Regulations of studies in force at the University of Rzeszów.

Rzeszów, date Click here to enter the date r	..........................................................................

/ Legible signature of the candidate /

The administrator of personal data is the University of Rzeszów, Aleja Rejtana 16C, 35-959 Rzeszów, represented by the Rector.

The Data Protection Officer at the University of Rzeszów is Krystian Antochów, e-mail address: antochow@ur.edu.pl.

Personal data of the candidate will be processed in order to carry out the recruitment process for higher education at the University of Rzeszów on the basis of art. 6 sec. 1 letter a of the Regulation of the European Parliament and of the Council (EU) 2016/679 of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free movement of such data and the repeal of Directive 95/46 / EC (General Data Protection Regulation ) (Journal of Laws EU L 119 of 4 May 2016.

Personal data of the candidate will be kept for the period necessary to conduct the recruitment process for the academic year 2018/2019:

1) in the case of recruitment for the winter semester - from 14/05/2018 to 31/10/2018,

2) in the case of recruitment for the summer semester - from 17/12/2018 to 28/02/2019.

The candidate has the right to require access to personal data from the administrator of the data, rectify it, delete or limit the processing, the right to object to the processing, as well as the right to transfer the data.

The candidate has the right to file a complaint to the Office for the Protection of Personal Data, if it is justified that their personal data are processed by the administrator of the data in breach of the general regulation on the protection of personal data of 27 April 2016.

Providing personal data is obligatory under the law - the regulation of the Minister of Science and Higher Education of 16 September 2016 on the documentation of the course of studies (Journal of Laws of 2016, item 1554, as amended), however, not providing data in the extent required by the administrator of personal data will be tantamount to resignation of the candidate from the recruitment process.

Pursuant to the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free movement of such data and the repeal of Directive 95/46 / EC (General Data Protection Regulation - RODO) I consent to the processing of my personal data for the needs of the University of Rzeszów related to the recruitment process.

Rzeszów, date Click here to enter the date	..........................................................................

/Legible signature of the candidate /

(To be signed in the case of resigning from the program)

CONFIRMATION OF RECEIPT OF DOCUMENTS

I confirm receipt of the documents

Rzeszów, date:	..........................................................................

/ Legible signature of the candidate /

NOTE-Documents are collected by the candidate in person or by a person authorized by the candidate. Authorization should include confirmation of the authenticity of the signature of an authorized person by a notary public or secondary school or company (if the candidate works).

* mark appropriately

** delete as appropriate