Exchange Faculty Application Form

Please return to:
International Relations Office
2 Abay Ave., Office 409/Dostyk
				
Tel:  +7 272 2704480 (#2107)
Fax: +7 272 2704211
E-mail: yuliyar@kimep.thinkdev.link 

Personal Information

First name: (as  in  passport)	Family name: 
	
Department:	Position:	
Sex:    Male         
           Female	Date of Birth:          day/ month / year  /  
	
Citizenship:	Passport number:

Place of issue:	Date of issue:

Date of expiry:	
Address in Almaty:		
Contact phone:
Mobile phone:		E-mail:	

Person to contact in case of emergency: 	

Address:		
Home and Mobile phone:		

Indicate a partner institution and program  you are applying for: 

________________________________________________________________________________
________________________________________________________________________________

Expected period of stay ______________________________

•	Please write a short essay (2-3 paragraphs) describing your motivation.  
•	Tell about your background and how beneficial the program will be for you and KIMEP.
•	Elaborate on  Purpose of Statements (courses, research) shortly
•	Please use this field only.

                    Name and  Signature			Date