Study Tours to Poland

I consent* to the use of my personal data by the Foundation "Leaders of Change" (Warszawa, Al. Jerozolimskie 133/56), hereinafter referred to as the Administrator, and the Borussia Foundation (Olsztyn, ul. Zyndrama z Maszkowic 2), hereinafter referred to as the Personal Data Controller, with purpose:

1. processing of statistical information related to the recruitment process for participation in the Study Tours to Poland Program, necessary for the fulfillment of the statutory obligations of the Administrator and the Personal Data Operator;

2. direct marketing of services in the area of the subject matter of the aforementioned Funds, including the conduct of research involving profiling (the use of personal data to create a profile of the beneficiary, taking into account the services in which he may be interested);
3. analysis of satisfaction from a cooperation with the Administrator and the Operator of personal data or their partners, as well as satisfaction from the services provided;

4. data collection for archiving.

At the same time, we inform that the candidate has the right to withdraw consent at any time (data is used until consent is withdrawn). The candidate has the right to access the data, the right to correction or deletion, restriction of use, and the right to object and appeal to the supervisory authority or to transfer the data.

* Consent is a mandatory condition for applying for participation in the competition of the Study Tours to Poland Program. Lack of consent makes it impossible.

Personal data

Surname

Name

Surname in Cyrillic transcription
(Moldavian candidates please insert into this field: no applicable)

Name in Cyrillic transcription
(Moldavian candidates please insert into this field: no applicable)

Date of Birth

/ /

Place of Birth

Sex

Female

Male

Do you have a passport?

YES

Series and number of foreign passport

Passport validity from:

/ /

to:

/ /

Do you have an open Schengen visa that will be valid from October to November 2025?

YES

Specify the validity period of the visa from:

/ /

to:

/ /

Copy of the passport
(candidate's data page only)

File name
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Do you have a Pole's Card?
(information does not affect the evaluation of the application)

YES

Address

please provide the address of actual residence (not registration)

Street, house, apartment number

City

Index

Other country

Contact

Mobile number (with country code)

Link to a personal profile on social networks (Facebook or Instagram)

Email
(Correspondence with participants will be sent by e-mail, so the indication of an e-mail address is obligatory!)

Place of study

University - full name

Faculty

Specialty

Year of study

University city

University website

Which?

The average score for 2 completed semesters.

on a rating scale (from-to)

Attach a copy of the grade book or its electronic equivalent* with marks for 2 completed semesters.
*The attached document must indicate the name of the university and the full name of the student

File name
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Candidate about himself

Where do you direct your activity outside of school hours? For example, in student organizations, NGOs, informal movements, volunteering, or interest groups?
If yes, briefly describe the history and nature of your activities over the past 2 years (2023-2025).
What specific role did you play in these activities? (e.g. participation, support, coordination, volunteering, etc.)

What activities have you been most proud of in the last year?

Participation in international programs

including student exchanges and studies outside your university, for example, within ERASMUS+

Full name of the project/program/internship/scholarship

Implementation form

stationary

online

City and country of implementation of the project/program/internship/scholarship (for stationary)

Period (full date) of the project/program/internship/scholarship

Where was information about this project/program/internship/scholarship obtained?

What have you learned? Describe in 3-5 sentences

Have you ever been a member of the visits organized as part of Study Tours to Poland?

YES

Website address

Where from?

Language skills

STP visits for students are conducted in two working languages: Ukrainian groups - in Ukrainian, Ukrainian-Moldovan groups in English. Please REALISTICALLY ASSES YOUR ENGLISH LANGUAGE SKILLS - it will be used to qualify you for a specific group. By qualifying for the right group, you will be able to feel comfortable and take full advantage of yours visit.

Do you have a certificate confirming this?

YES

Attach a scan of the certificate

File name
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Have you had any experience of active communication in English language? If yes, under what circumstances?

Contacts with Poland

Have you been to Poland before?

Yes, several times

Yes, once

No, never

What?

Motivation

Why do you want to come to Poland for a study visit? (minimum 500 - maximum 1000 characters)

1000 Characters left

What challenge have you taken on in the last year? What influenced your decision to do so? (minimum 500 - maximum 1000 characters)

1000 Characters left

What do you associate Poland with? Give 3 examples, briefly justifying them
1.

Attach a recommendation letter written by the head of a public organization, a representative of the student council, a leader of the volunteer movement, etc., according to the instructions (see the introduction to the questionnaire)

File name
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Elementy kontrolne

Zarejestrowany