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APPLICATION FORM
LIETUVOS KÛNO KULTÛROS AKADEMIJA
LITHUANIAN
ACADEMY
OF PHYSICAL EDUCATION
Sporto g. 6, LT-44221 Kaunas
Phone: + 370 37 30 26 21, Fax: + 370 37 20 45 15, E-mail: lkka@lkka.lt, Website: http://www.lkka.lt
APPLICATION FORM FOR ADMISSION
(Complete the form clearly in CAPITAL letters)
PERSONAL DATA
* Please write family and given names exactly from your passport (or ID card) as it is very important while preparing your acceptance documents.
Family name
First and middle name(s)
Place of birth
Date of birth (D /M/ Y)
Sex
Male
Female
Nationality
PRESENT MAILING ADDRESS:
Street
City
Postal code
Country
Address valid until (D /M/ Y)
PERMANENT HOME ADDRESS (if different):
Street
City
Postal code
Country
Phone
Fax
E-mail address
PERSON TO BE CONTACTED IN CASE OF EMERGENCY
Name
Relationship to the student
Contact information
Secondary education
Type of secondary school leaving certificate
Issuing country
Dated (D /M/ Y)
University education
List all higher education institutions you have attended or are attending
Institution:
Dates:
Institution:
Dates:
Institution:
Dates:
LINGUISTIC COMPETENCE
The language in which you plan to study
Listening skills
basic
intermediate
advanced
Writing skills
basic
intermediate
advanced
Speaking skills
basic
intermediate
advanced
Reading
skills
basic
intermediate
advanced
ENCLOSURES
ENCLOSURES
Secondary school leaving certificate
Certificate of knowledge of English or Russian
2 passport size photos
Application form for accommodation
SIGNATURES
I certify that the information provided in this application is correct and complete.
Applicant’s signature
Date