UNIVERSIDAD DEL PAÍS VASCO EUSKAL HERRIKO UNIBERTSITATEA UDA IKASTAROAK / CURSOS DE VERANO ONLINE REGISTRATION FORM FOR PENAF – ONLINE: EXPERIMENTAL PROGRAM OF NEW ONLINE TRAINING ACTIONS 2015 PERSONAL DETAILS Surname Name Address City code City State / Province Nationality Date of birth Passport number Tel. E-mail Male Female Fill with CAPITAL LETERS City/country from which you will follow the online course PROFESSIONAL FORMATION (1)Qualification Occupation --------------------------------- (2) ---------------------------------- (3) :Currently studying or completed studies --------------------------------------- (1) (2) (3) Fill in according to the added list REGISTRATION V.1 Eskola 2.0 eta IKTen erabilera ikastetxean 75 € V.2 Hezkuntza eleanizduna: gaitasun eleanizduna eta translanguaging / Multilingual education: multilingual competence and translanguaging 75 € V.3 Educación sexual en la Educación Secundaria Obligatoria 75 € V.4 Ikasteko kooperatu / kooperatzen ikasi, ikasgelan. Ikaskuntza kooperatiboa 75 € V.5 Prevención e intervención en situaciones de agresión, violencia y acoso, en la familia y en la escuela 75 € V.6 Eskola 2.0 eta IKTen erabilera ikasgelan 75 € V.7 Introducción al Derecho Penal europeo 75 € RETURN TO: th Please, send registration and method of payment, before 9 of February. [email protected] METHODS OF PAYMENT  Bank transfer Please send proof of transfer made to Summer Courses account. BBVA ES95 – 0182 – 5709 – 48 – 0010010034  Credit card Owner Credit card number Expire date RECEIPT Summer Courses Organization will send you a receipt. If you need this receipt to be made payable to another person or institution, please, fill the following chart. Name / Institution Address City code City State / Province Tel. E-mail Passport number REFUNDS If your registration form is not accepted, the registration fee will be reimbursed to you. Refund will be done to the following Bank Account: IBAN Office Branch D.C. Bank Account OTHER INFORMATIONS ‐ ‐ ‐ th The answer to your application form will be communicated by email, on 10 of February of 2015. The registrations will be obtained by order of receipt. 25 minimum registrations are needed to form a group. The group will have registered 40 Maximum. MODIFICATIONS AND CANCELLATIONS • • • • The registration may be modified before February 9. After date modifications will not be permitted. Cancellations: up to 5 days before the starting date of each course. The entered amount, except management amount €10 will be refunded. To cancel a course cancellation form must be sent to [email protected]. Once the course is started, cancellations will not be allow. PROFESSIONAL FORMATION (1) Qualification Elementary School Code 1 (3) Currently studying or completed studies Anthropology Code 21 High School 2 Architecture University Student 3 Architectural Technologist 22 23 University Degree 6 Fine Arts 24 University B.A. 7 Environmental Sciences 25 PhD 8 Biology 26 Others 9 Education 27 Politics 28 Law 29 Code Economy 30 Civil Service 60 Business 31 Health Sciences 61 Nursing 32 Building Industry 62 Pharmaceutical Sciences 33 Unemployed 63 Languages 34 Business 64 Philosophy 35 Education 65 Physics 36 Student 66 Geography 37 Industry 67 Geology 38 Retired 68 History 39 Housework 69 Computer Sciences 40 Liberal Profession 70 Engineering 41 Service sector 71 Engineering Technician 42 Others 72 Literature 43 (2) Occupation Teaching 44 Mathematics 45 Medical Sciences 46 Nutrition 47 Journalism 48 Psychology 49 Chemistry 50 Labour Relations 51 Sociology 52 Social Work 53 Tourism 54 Others 55 In compliance with the duty of information stated in art. 5 of the Personal Data Protection Act 15/1999, of 13 December, we would like to notify you that your personal details will be recorded on the Fundación Cursos de Verano file [Summer Courses Foundation] which is the title and responsible party for this file. The purpose of this file is to organise the courses and manage the administrative activities derived from your relationship with us. If you wish, you may exercise your right to access, correction, opposition and/or cancellation of this data, according to the provisions established in current legislation, by writing to Fundación Cursos de Verano, Paseo de Miraconcha nº 48 (Palacio Miramar), San Sebastián, 20007 (Gipuzkoa) or by sending an e-mail to: [email protected]