RECORD SHEET 
For the enrolment to doctoral study at FA UP  

Palacký University Olomouc         	Starting year: 

Faculty of Arts                             	Study programme: ...................................................

Study form: full time – part time           

Last name (in block capitals):

First name:

Title:	

Date of birth:

Place of birth:                                                                       Nationality:

Permanent address:

Post code:
	
Contact address (do not complete if it is the same as permanent address):

Post code:
	
Telephone:

E-mail:  

Account number (only full-time students):

I hereby declare that pursuant to Act No. 101/2000 Sb., on the protection of personal data and the change of some laws, as amended, I agree with the processing of my personal data for the needs of statistics and for the record keeping of students at Palacký University Olomouc. 

Date of study enrolment:    

Signed by the student:                           

NB: Please complete the form legibly in block capitals.  
In case there is any change in the abovementioned data during your studies, please inform the FA UP Doctoral Study Officer as soon as possible.