Questionnaire for admitted pupils for the school year 2024/2025 (correct version)

QUESTIONNAIRE FOR NEW STUDENTS

Fields marked with a red asterisk are mandatory.

Information about the pupil:

Select a class

1.EE Electrical Power Engineering and Electrical Machines (class Mgr. Ludmila Petržalová)

1.EM Electromobility and alternative drives (clas. u. Mgr. Radek Mach)

1.ER Robotics and Control Technology (class of Mgr. Zuzana Šímová)

1.S Mechanical Engineering (class of Ing. Václav Vávra, Ph.D.)

Student registration number (six-digit number identical to the registration number in the DiPSy system):

Name:

Last name:

Birth number including slash (if the pupil does not have a birth number, add 0000):

Date of birth:

Place of birth:

Nationality:

ID card number (if the student already has one):

Phone number:

E-mail:

Name of the health insurance company:

Health insurance company code:

Permanent residence:

Address:

City:

ZIP CODE:

Transient residence (if the student does not have a transient residence, do not fill in):

Address:

City:

ZIP CODE:

Enter the name and address of the previous school (typically primary school):

Indicate any disability:

List any medical conditions with which the teacher should be familiar (e.g. asthma, allergies, diabetes, etc.):

Upload a student ID photo measuring 2.8 cm in width and 3.4 cm in height. Before uploading, name the photo as follows: prijmeni_jmeno_den_mesic_rok_narodeni. Allowed formats are .jpg and .png.

Choose a correctly named photo

Information about the legal representative(s):

First legal representative:

mother

father

Trustee

Name:

Last name:

Titles:

Phone number:

E-mail:

Residence:

Address:

City:

ZIP CODE:

Occupation:

The office phone:

Second legal representative:

mother

father

Trustee

Name:

Last name:

Titles:

Phone number:

E-mail:

Residence:

Address:

City:

ZIP CODE:

Occupation:

The office phone:

By submitting this questionnaire, I agree to the processing of personal data in accordance with Regulation (EU) No 2016/679 of the European Parliament and of the Council (GDPR).

By submitting this questionnaire I agree to order an ISIC card. The payment for the ISIC card will be charged to the school cashier.