ERASMUS APPLICATION FORM
to Lodz University of Technology, Poland
ACADEMIC YEAR 2023/2024
Surname (Family Name)
Dizdar
First Name
Middle Name(s)
Ivan
Home Address
Phone +385919002739
Bribriskih Knezova 35, 22000 Šibenik, Croatia
e-mail ivandizdar666@gmail.com
Date of Birth
Sex
2002-11-01
MALE
Disability
Nationality
Yes
Citizenship
Croatia
No
At which university are you studying at present?
Polytechnic of Šibenik, Croatia
Level of study:
Your year of study at home university ______ Degree for which you are studying at present? __________
In which faculty will you study/do placement at Lodz University of Technology?
INTERNATIONAL FACULTY OF ENGINEERING
Name your faculty at Home University
____________________________________________________________________________
Name your academic Supervisor or Contact at Home University, e-mail, address, phone number
Frane Urem, frane.urem@vus.hr, +385 22 311 060
Name your academic Supervisor or Contact at Lodz University of Technology (if known)
____________________________________________________________________________
Period of exchange
winter semester 2023/24
Would you like TUL to arrange accomodation for you (on the TUL campus)?
x Yes
No
Would you like to take the course on the Polish language and culture (the course is free of charge)?
Yes
x No
Signature of the Erasmus Coordinator at Home University:
Stamp of the Sending University:
International Office
Please return this form to:
Incoming students for the IFE and TUL
International Faculty of Engineering
Lodz University of Technology
PL 90-924 Lodz, 36 Zwirki
Tel: +48 42 638 38 00, fax: +48 42 636 06 52
E-mail: admin@ife.p.lodz.pl