APPLICATION FORM FOR HUNGARIAN UNIVERSITY AND RESEARCH SCHOLARSHIP

BALASSI INSTITUTE HSB OFFICE H-1519 Budapest, P.O. B. 385 www.scholarship.hu

Type of schola sh!p"

Az sztnd ! t pusa

"#B n$il%&ntart&si sz&'

H(B )e*istration nu'+er

APPLICANT#S DATA A P$LY$%& ADATAI

,a'il$ na'e -as in passport. /ezet01n0% -'int az 2tle%0l+en. 3i%en na'e-s. -as in passport. 4eresztn0% -'int az 2tle%0l+en. Ho'e 5ountr$ 6 5itizenship -i7 di77erent. Orsz&*68lla'pol*&rs&* -ha elt0r9. Place o7 +irth -cit$,countr$. (z:let0si hel$ -%&ros, orsz&*. ;ate o7 +irth -da$,'onth,$ear. (z:let0si d&tu' -nap,h<,0%. "other=s 'aiden na'e An$!a le&n$1ori ne%e 3ender >e'e )esidence 8lland< la1c ' 5ountr$,Postcode Orsz&*, ir&n$ t<sz&' 5ount$,Aown "e*$e, %&ros (treet,>r. Btca, h&zsz&' Postal address -i7 di77erent. Ce%elez0si c ' -ha elt0r9.

Please, insert $our photo here ,0n$10p hel$e

,e'ale "ale

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Passport >o. ?tle%0lsz&' "arital status 5sal&di &llapot

(in*le "arried

@*$ed:l&ll< H&zas

@-'ail address @-'ail c '

Phone nu'+er -includin* Area 5ode. Aele7onsz&' -el9h %<sz&''al . Occupation ,o*lal1oz&s

>a'e o7 @'plo$er, address "un1ahel$ ne%e, c 'e

1 A D se'ester6partial studies -3-1E 'onths. A - r0sz10pz0s -3-1E h<nap. B - post*raduate studies -3-F1 da$s or 1-1E 'onths. B - poszt*radu&lis tanul'&n$o1, 1utat&s -3-F1 nap %a*$ 1-1E h<nap. 561 - 7ull Ph; pro*ra''e -3G 'onths. 561 - tel!es Ph; pro*ra' -3G h<nap. 56F - partial Ph; studies -1F 'onths. 56F - do1tori r0sz10pz0s -1F h<nap. ; - postdoctoral studies, research -1-1E 'onths. ; - posztdo1tori tanul'&n$o1, 1utat&s -1-1E h<nap. @ - research sta$ -3-F1 da$s or 1-1E 'onths.. @ - %ezet9-o1tat<i %a*$ 1utat<i 10pz0s -3-F1 nap %a*$ 1-1E h<nap. , - su''er courses -F-H wee1s. , D n$&ri e*$ete' -F-H h0t.

APPLICATION#S DATA 'TYPE A(E) A P$LY$%AT ADATAI 'A(E T*PUS)

Host Institution, ,acult$F ,o*ad< int0z'0n$, 1ar >a'e o7 the Host ,o*ad< sze'0l$ ne%e Ha%e letter o7 acceptance3 /an-e 7o*ad<le%0lJ

1. F. 3. )e7erences= na'e -Occupation6Position. Business phone, @-"ail A!&nl<1 ne%e -7o*lal1oz&s6+eoszt&s. "un1ahel$i tele7on, e-'ail ,ield o7 )esearch A p&l$&z< 1utat&si ter:lete Can*ua*e o7 instruction A tanul'&n$o161utat&s 7ol$tat&s&na1 n$el%e Planned duration o7 scholarship Az sztnd ! ter%ezett id9tarta'a Proposed date o7 arri%alH -da$, 'onth, $ear. Az 0r1ez0s ter%ezett d&tu'a

APPLICATION#S DATA 'TYPE F) A P$LY$%AT ADATAI 'F T*PUS)

>a'e o7 the course or*anizer institute 4urzust szer%ez9 int0z'0n$ ne%e Aitle o7 the course A 1urzus c 'e ;ate and duration o7 the course 4urzus id9pont!a, id9tarta'a

1.

F.

3. )e7erence=s na'e -Occupation6Position. Business phone, @-"ail A!&nl< ne%e -7o*lal1oz&s6+eoszt&s. "un1ahel$i tele7on, e-'ail Can*ua*e o7 instruction A tanul'&n$o1 7ol$tat&s&na1 n$el%e

F In case o7 *raduate or post*raduate studies onl$ applications to state institutions can +e accepted. )0sz10pz0sre 0s poszt*radu&lis tanul'&n$o1ra csa1 &lla'i 7els9o1tat&si int0z'0n$e1+e lehet p&l$&zni. 3 Kithout the letter o7 acceptance, the acceptance o7 the candidate cannot +e *uaranteed. ,o*ad<le%0l n0l1:l 10ts0*es, ho*$ a p&l$&z<t a %&lasztott 'a*$ar 7o*ad<int0z'0n$e tud!a-e 7o*adni. H Bnder*raduatesL ,e+ruar$ or (epte'+er )0sz10pz9s1 eset0+enL 7e+ru&r %a*$ szepte'+er F

EDUCATIONAL BAC+GROUND
TANULM$NYI H$TT,R Hi*her @ducation Institution, Cocation ,els97o12 tanul'&n$o1 int0zete, hel$e Mears attended -7ro'-to. Aanul'&n$o1 1ezdete-%0*e ,ield o7 stud$ Audo'&n$ter:let

1. F. 3. Acade'ic de*ree awarded "e*szerzett tudo'&n$os 7o1ozat student Bachelor=s de*ree "aster=s de*ree Ph; hall*at< BA "A Ph;

LANGUAGE +NO-LEDGE
NYELVISMERET eNcellent 1i%&l< Hun*arian 'a*$ar @n*lish an*ol *ood !< 7air 'e*7elel9 poor *$en*e o77icial eNa' ta1en hi%atalos n$el%%izs*a 1elte le%el6point szint6pont

OTHER
EGY,B Ha%e $ou pre%iousl$ studied or wor1ed in Hun*ar$J I7 so, please speci7$ Aanult %a*$ dol*ozott 1or&++an "a*$arorsz&*onJ Ha i*en, r0szletezzeO Ha%e $ou +een a scholarshipholder in Hun*ar$ durin* the past three $earsJ I7 so, please speci7$ /olt-e az ut<++i h&ro' 0%+en sztnd !!al "a*$arorsz&*onJ Ha i*en, r0szletezzeO Are $ou in the course o7 appl$in* 7or an$ other scholarshipsJ I7 so, which one-s. and at which institutionJ Pelenle* %an 7ol$a'at+an sztnd !p&l$&zataJ Ha i*en, 'il$en szer%ezetn0lJ Person to +e contacted in case o7 e'er*enc$ -na'e, address, phone, e-'ail. (:r*9ss0*i eset+en 0rtes tend9 -n0%, c ', tele7onsz&', e-'ail. An$ other co''ents @*$0+ 'e*!e*$z0se1 I here+$ certi7$ that all in7or'ations *i%en in this 7or' are true and correct. I understand that I shall +e responsi+le 7or an$ eNpenses which cannot +e co%ered +$ the scholarship. Ahis 7or' is to +e co'pleted in F copies in @n*lish or Hun*arian lan*ua*e -one o7 the' 'ust +e ori*inal.. ,or's 7illed in an$ other lan*ua*es will not +e processed. 4i!elente', ho*$ a 7enti adato1 'e*7elelne1 a %al<s&*na1. Audo'&sul %esze', ho*$ az sztnd ! &ltal ne' 7edezett 1lts0*e1 tel!es e*0sz0+en en*e' terhelne1. @zt a 10rd9 %et F p0ld&n$+an 'a*$ar %a*$ an*ol n$el%en 1ell 1itlteni 0s +e1:ldeni -le*al&++ az e*$i1 p0ld&n$ eredeti le*$en.. "&s n$el%en 1itlttt p&l$&zati adatlapo1 ne' 1er:lne1 7eldol*oz&sraO ;ate ;&tu' ................................................................ (i*nature Al& r&s ................................................................................