Application Form for a Student/Foreigner

This program is addressed to adult (18+) foreigners living in Wrocław or the surrounding area.
Participation in this program is FREE. The Polish language is taught by volunteers. We are NOT a language school.

Please, fill out the following form precisely.

If you are visually impaired or blind, we provide support at the telephone number +48 504 799 356 (this form contains Google Map and the picture with anti-spam security code).

Your name (required):

Your surname (required):

Sex (required):

Age (required):

E-mail (required):

Phone number (required):

Your Polish level (required):

Your native language (required):

Specify other languages you know (may be according to your own self-assessment):

language 1: , level:

language 2: , level:

language 3: , level:

language 4: , level:

Nationality (required):

Select the area (on the list under the map) in which you want to meet with volunteer to learn Polish. Multiple areas can be selected. Click on a colored area on the map to check the area number. If you can meet anywhere in Wrocław, check the "FACE-TO-FACE: ANYWHERE IN WROCŁAW" option (required):

ONLINEFACE-TO-FACE: ANYWHERE IN WROCŁAWFACE-TO-FACE: AREA AFACE-TO-FACE: AREA BFACE-TO-FACE: AREA CFACE-TO-FACE: AREA DFACE-TO-FACE: AREA EFACE-TO-FACE: AREA FFACE-TO-FACE: AREA GFACE-TO-FACE: AREA HFACE-TO-FACE: AREA IFACE-TO-FACE: AREA JFACE-TO-FACE: AREA KFACE-TO-FACE: AREA LFACE-TO-FACE: AREA NFACE-TO-FACE: AREA OFACE-TO-FACE: AREA PFACE-TO-FACE: AREA QFACE-TO-FACE: AREA RFACE-TO-FACE: AREA SFACE-TO-FACE: AREA TFACE-TO-FACE: AREA UFACE-TO-FACE: AREA VFACE-TO-FACE: AREA W

Preferred meetings days (and time) with a volunteer (required):

How did you learn about our program? (required):

Comments:

Declaration of the place of residence (required):

READ: INFORMATION ON PROCESSING PERSONAL DATA BY WROCŁAW INTEGRATION CENTRE

I declare that I read the following information about processing of personal data by the Wroclaw Integration Center, understand the content of this information and I hereby give consent for my personal data contained in this application form to be processed.

I acknowledge that WCI may contact me by phone or email to obtain information on the functioning of a given language tandem / group and other issues related to my participation in the program "Wrocław na językach świata".

I declare that I will not use the contact details of the volunteer for purposes other than organizing language tandem / group meetings implemented as part of the program "Wrocław na językach świata".

I declare that I am an adult.

Input this code: