LAST NAME
MIDDLE NAME (if any)
FIRST NAME(S)
ENROLMENT NO.
CURRENT ADDRESS:
STREET
NR
ZIP CODE
CITY
PERMANENT ADDRESS:
STREET
NR
ZIP CODE
CITY

PHONE
E-MAIL
MOBILE
SEX	Male Female
BIRTH DATE	DD MM YYYY
PLACE OF BIRTH
NATIONALITY
DEGREE PROGRAM
TYPE OF DEGREE
UNIVERSITY CAMPUS PRESENTLY ATTENDING
CURRENT SEMESTER
YEARS OF ENGLISH (SCHOOL)
SEMESTERS OF ENGLISH (UNIV.)

PHOTO (PNG oder JPEG, max. 8 MB)
APPLICATION DOCUMENTS (PDF, max. 8 MB)

EMERGENCY CONTACT PERSON for any unexpected situations (e.g. sudden and serious illness, accident, non-arrival on expected flight, ...): I allow the coordinators of the Summer School Program to contact the person(s) mentioned below in all of the matters described above and similar situations which require immediate decisions and/or solutions. I waive my right to confidentiality for this type of communications.

LAST NAME
FIRST NAME(S)
STREET
NR
ZIP CODE
CITY

PHONE
E-MAIL
15 + 3

IMPORTANT NOTICE: We will contact you with payment instructions after acceptance into the program. I am aware that I will need to apply for the relevant visa in time. (The information about the procedures will be provided by Coastal Carolina University.) I will take part in all of the prescribed events and activities before and during the program. Failure to do so may result in exclusion from the program without any reimbursement of fees or deposits.

I ACCEPT THE ABOVE CONDITIONS AND I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND ACCURATE.