Dotazník pro přijaté žáky na školní rok 2024/2025 (správná verze) (#11)

QUESTIONNAIRE FOR NEW STUDENTS

Pole označená červenou hvězdičkou jsou povinná. V případě zakrytí části dotazníku postraní lištou si prosím dotazník kombinací kláves CTRL a + přibližte, tím problém odstraníte.

Information about the pupil:

Select a class

1.EE Elektroenergetika a elektrické stroje (tř. u. Mgr. Ludmila Petržalová)

1.EM Elektomobilita a alternativní pohony (tř. u. Mgr. Radek Mach)

1.ER Robotika a řídicí technika (tř. u. Mgr. Zuzana Šímová)

1.S Strojní inženýrství (tř. u. 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.):

Nahrajte průkazovou fotografii žáka o rozměrech 2,8 cm na šířku a 3,4 cm na výšku. Fotografii před nahrátím pojmenujte následovně: prijmeni_jmeno_den_mesic_rok_narozeni. Povolený formát je pouze .jpg.

Vybrat správně pojmenovanou fotografii

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 my personal data in accordance with Regulation (EU) No 2016/679 of the European Parliament and of the Council (GDPR).

Want to order an ISIC card? By ticking YES, you agree to order an ISIC card. Payment for the ISIC card will be charged to the school cash register.

YES