PAIDEIA REGISTRATION FORM
PERSONAL DETAILS
Please use block letters (as written in your passport)
FAMILY NAME ... .Mr. Ms
NAME ...
NATIONALITY CITIZENSHIP .. .
PLACE & DATE OF BIRTH ...
PERMANENT HOME ADDRESS .
..
..
TELEPHONE ...
E-MAIL .
ACADEMIC INFORMATION
MAJOR FIELD OF STUDIES .....................................................................
MINOR FIELD OF STUDIES .
DEPARTMENT / SCHOOL OF ENROLLMENT ..
..
UNIVERSITY/COLLEGE ...
YEAR OF ENROLLMENT .
COURSES YOU WILL ATTEND IN SUMMER 2007.
1. ..
2. ..
3. ..
4. ..
5. ..
6. ..
PLEASE STATE REASONS FOR CHOOSING EACH ONE OF THE ABOVE MENTIONED COURSES
1. ......
2. ......
3. ..
4. ..
5. ..
6. ..
COURSES IN GREEK OR OTHER CIVILIZATIONS YOU MIGHT HAVE TAKEN
1. ..
2. ..
3. ..
REASONS OF MOTIVATION FOR PARTICIPATING IN RHODES PROGRAM
...
FOREIGN LANGUAGES OTHER THAN ENGLISH (please state the level in each language)
1. ...
2. ...
3. ...
DATE SIGNATURE ..