CHARLES UNIVERSITY IN PRAGUE 

FACULTY OF PHYSICAL EDUCATION AND SPORT 

APPLICATION FOR ADMISSION
DEGREE BACHELOR
PROGRAMME PHYSIOTHERAPY
FORM OF STUDY FULL-TIME
ACADEMIC YEAR  
PERSONAL DETAILS
APPLICANT'S FULL NAME (first name and family name)  
DATE OF BIRTH  
PLACE OF BIRTH  
NATIONALITY  
PERMANENT ADDRESS  
PASSPORT NUMBER  
EMAIL ADDRESS  
TELEPHONE  
DOCTOR'S REPORT ON APPLICANT'S HEALTH AND PHYSICAL CONDITION 

 

 

 

 

                                                                                                                    Signature and seal 

I declare that all above mentioned personal data are true and I did not conceal any important facts.

Date:                                                                                                         Applicant's signature

  The application form was received on:   

 

                                                                                                                 Signature and Institution seal