CEU PERSONAL INFO SHEET
Please complete in typescript or in block letters using black ink.
SEND THIS SHEET TO THE OPEN SOCIETY FOUNDATION BRATISLAVA ONLY

Personal Information:

Surname/Last Name/Family Name: _________________________________________________________
First Name/Other Names: _________________________________________________________________
Married ٱ  Single ٱ               Male ٱ  Female ٱ                  Mrs. ٱ  Ms. ٱ  Mr. ٱ

Correspondence Address (including Post Code):
______________________________________________________________________________________
______________________________________________________________________________________

Telephone Number: _________________________ Fax Number: _________________________________
Valid until: _______________________

Permanent Address (including Post Code):
______________________________________________________________________________________
______________________________________________________________________________________
Telephone Number: _________________________ Fax Number: _________________________________
E-mail: ___________________________________ 

Date of Birth: ______________________________ Country of Birth: ______________________________
Nationality:  _______________________________ Citizenship:  __________________________________
Country of Permanent Residence: ___________________________________________________________
Passport Number: __________________________ Valid Until: ___________________________________

Applying to:

Department 1 _______________________________   Streams __________________________________
Department 2 _______________________________   Streams __________________________________
Doctoral support program 	_______________________________________________________________

Declaration: 

I confirm that, to the best of my knowledge and belief, the information given on this form is complete and accurate and that I have completed this form personally.
If any inaccuracies in the information provided by you are discovered at any stage of the selection process, your application may be disqualified at any stage of the selection process

Applicant’s Signature: ______________________________________ Date: ____________________

* Please note that this cover sheet will be sent only to the Open Society Foundation in Bratislava for its records.