Collegium Civitas, Department for Scholarships

Palace of Culture and Science, 12th Floor

00-901 Warsaw, Pl. Defilad 1
Tel.: (022) 656 71 81, fax: (022) 656 71 85
email: stypendia@civitas.edu.pl,

Name and surname: …………………………………………. Warsaw, …………….……………….........

Year, programme: ………………………………………….
Enrolment number: …..………………….................
Mode: Full-time/part-time*

Application for a Rector’s scholarship for the best students

in the .......................... semester of the academic year..............................

1. high grade point average:

grade point average: academic year …………….…….......….; .................... semester – …………..........
grade point average: academic year …………….…….......….; .................... semester – …………..........

2. outstanding sporting achievements in international or national competitions:

..............................................................................................................................................
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...

3. academic and artistic achievements:

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...

Please transfer the Rector’s scholarship for the best students to the following bank account number:
………………………………..……
Name and surname of the bank account owner

……………………..………………
Street, house number, apartment number

………………………..……………
Postal code, town

Bank …………………………..…………………..……………....................………………………………….
Bank account number ……………………………………………………………………………………………………........

I represent that the information I have provided is true.

……..............…………………………………………….
Signature of the student – applicant
*delete as appropriate

THE FOLLOWING DOCUMENTS MUST BE ATTACHED TO THE APPLICATION:

1. a certificate stating the grade point average from the previous higher education institution (the last two semesters
separately), including the grading scale, for students in the first year of a second-cycle programme
2. a certificate confirming outstanding sporting achievements
3. a certificate confirming academic and artistic achievements
4. A representation stating that no scholarship has been applied for at any other higher education institution