APPLICATION FOR ADMISSION
Exchange students – Distance course
EXCHANGE PROGRAM
Inter-university bilateral agreement
PERSONAL DATA
Family name
Alam
First (given) name
Usman
City of birth
Gujrat
Country of birth
Pakistan
Date of birth (Year-month-day)***
1982-10-01
Identification number (OIB)
Female
Male
Permanent address in home country
Mullah Islam Nagar, Street # 14
City
Gujrat
Postal code
50700
Country
Pakistan
Telephone
0046-0760602926
E-mail
Uam10001@student.mdh.se
HOME INSTITUTION
Home university
Mälardalen University, Västerås, Sweden
Department
School of Innovation, Design and Engineering, Software Engineering Division
Contact person (Departmental Exchange Coordinator or other person responsible for the evaluation of your exchange
studies)
Prof. Ivica Crnković
Telephone
E-mail
+46 21 103183
ivica.crnkovic@mdh.se
Highest degree completed or in progress
Professor of Software Engineering
DISTANCE COURSE
Code
Course unit title
Enrolment date
ECTS credits
Distributed Software Development
2011-09-01
8
SIGNATURE
I confirm that to the best of my knowledge, the information given in this form is correct and complete:
Date
2011-09-13
*** Obligatory
Signature