* All sections are to be completed in BLOCK LETTERS.
* Enclose one set of supporting (academic) documents with this Application form.
* All documents must be certified.
Personal information
Surname/family name: ____________________________________________________________________
First Name(s): __________________________________________________________________________
Sex: __________________________________________________________________________________
Date of Birth: ___________________________________________________________________________
Nationality: _____________________________________________________________________________
Citizenship: _____________________________________________________________________________
Native language: _________________________________________________________________________
CONTACT INFORMATION for notifying you about the result of this application
Country: _____________________________________________________________________________
City: ________________________________________________________________________________
State or Province: ______________________________________________________________________
Postcode: ____________________________________________________________________________
Street: _______________________________________________________________________________
Telephone/Fax (incl. Area code): __________________________________________________________
E-mail: ______________________________________________________________________________
Mobile phone: ________________________________________________________________________
Russian language proficiency _____________________________________________________________
How would you describe your level of Russian: _______________________________________________
Please list secondary schools, colleges, universities and other schools you have attended.
For example:
Institution (name and location) |
Years of Attendance (from-to) |
Degree or diploma received |
Paris High School (France) |
1999 - 2002 |
High School Certificate |
Seoul National University (S. Korea) |
2002 - 2006 |
Bachelor degree in Arts |
Cornell University (USA) |
2006 - 2008 |
Master degree in Arts |
Institution (name and location) |
Years of Attendance (from-to) |
Degree or diploma received |
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ASIAC program wanted
ASIAC program wanted:
Degree program:
Field of study/designation: ________________________________________________________________________
Program name/field of study: ______________________________________________________________________
Courses: ______________________________________________________________________________________
Study period/Module number: _____________________________________________________________________
ADDITIONAL INFORMATION
Here you can write any information concerning your skills, interests or your questions to the Admission office:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Successful applicants will be sent an Invitation Letter which will be required for obtaining a student visa in the nearest Consulate of Russian Federation.
If you are planning to study in Yakutsk city we will be glad to welcome you in the Arctic State Institute of Arts and Culture.
Arctic State Institute of Arts and Culture, Department of International Relations
4, Orjonikidze Street, Yakutsk, 677000, Russian Federation
Fax: 7(4112) 34 -44-60
Phone: 7(4112) 42-11-67