Application for the Refugee Teachers Program The University of

Application for the Refugee Teachers Program
The University of Potsdam offers a course for foreign school teachers who have
come to Potsdam or its surroundings as refugees. The course will start on April
1st, 2016. Detailed information can be found at https://www.unipotsdam.de/studium/en/data-storage/zielgruppenbereich/refugees-welcomeopportunities-for-refugees/.
If you wish to apply for the course, please fill this form and send via mail, fax, or
email to Dr. Birgit Bismark by March 15th, 2016.
Mail:
Universität Potsdam
Dr. Birgit Bismark
Studierendensekretariat
Am Neuen Palais 10
14469 Potsdam
Fax:
+49 331 977-1798
Email:
[email protected]
Fill this form entirely, please:
First name(s):
_____________________________
Second name(s): _____________________________
Gender:
O male
O female
Year of birth:
_________
Email:
_____________________________
Telephone:
_____________________________
Please indicate which schools you have taught at:
From – until
(year)
School Name
Location and Country
Please specify the subjects you have taught:
Class Level
Please specify which schools and/or your higher education institutions
you attended:
From – until
(year)
Name of schools, colleges etc.
Location and Country
Please indicate which certificates and/or diplomas you can submit:
Please indicate your language skills with a cross:
Native
language
Good
Basic
None
Arabic
O
O
O
O
Persian (Dari, Farsi)
O
O
O
O
English
O
O
O
O
German
O
O
O
O
Other languages:
O
O
O
O
O
O
O
O
O
O
O
O
Has your status as refugee been officially approved?
O Yes
O No
What else would you like to let us know about you:
Place, Date
Signature
______________________
___________________________

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