DOCUMENT REQUEST FORM - School of Medicine in English JU MC

Personal Information

Surname (as it appears in your state-issued documents):

Name(s) (as it appears in your state-issued documents):

Status at the JU MC:

please specify below:

Year (in the current academic year; note: academic year lasts from October 1 through September 30 the following calendar year):

Year of graduation:

Date of birth (dd/mm/yy):

Place of birth (city, country):

E-mail address:

Note! Please make sure that the provided e-mail address is correct and functional as AN ACTIVATION LINK will be sent to it, as well as all correspondence with regard to this request. Requests for an alternative email address to be used for that purpose will NOT be acted on.

Requested document

For detailed information on the ordering process and the documents available, please visit here.

Official transcript of grades (hard copy issued in a sealed envelope):

Standard Letter of good standing:

please state the purpose for issuing the document, e.g job aplication, bank statement, etc,:

Expanded letter of good standing:

Please specify the required additional information not included in the Standard Letter of good standing):

Letter for legalization of stay (e.g. visa, temporary stay card):

In order for this document to be issued, please provide the following information. Please make sure that the information is consistent with the travel document that you will use to apply for the visa/ temporary stay card with.

Nationality:

Passport number:

Country issuing the passport:

Passport expiry date (dd/mm/yyyy):

Gender:

Summer clerkship letter:

Other:

Please specify what document you need. If you need a form filled out, please provide a link to the form. :

Document release instructions

Digital copy on MS OneDrive

I will personally collect the document(s)

I authorise the following to collect the document(s) on my behalf:

Surname:

Name:

ID document type:

Number of the ID document:

E-mail a scan to an institution
(Note: Digital copies in PDF format will only be emailed to institutions. They cannot be emailed to private persons):

Name of the institution:

Contact person – surname and name:

Role of the contact person at the institution:

Professional email address:

Mail the document(s):

By priority mail (free of charge)

Addressee/ Institution:

Street name and numer:

Post code:

City:

Country:

Annotation on the envelope (if applicable; e.g. Case reference number, Attn…, Re….):

By courier mail –
NOTE: When you choose this option, you will need to arrange the shipment of the document by yourself and provide the airway bill and shipment label for the office to use. The cost of the shipment is to be paid by you to the courier company you choose. Only arrange the shipment when you have received from the office an email with the information that the document is ready.

Comments / additional information

I agree for the processing of my personal data in the range required for the purpose of issuing the herein requested documentation in accordance with the Regulation of the European Parliament and of the Council (EU) 2016/679 of 27 April 2016 and in accordance with the information clause attached to my consent.

Pursuant to Art. 13 of Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46 / EC – referred to as "GDPR", the Jagiellonian University informs that: (1) The administrator of your personal data is the Jagiellonian University in Krakow. (2) The Jagiellonian University has appointed a Data Protection Officer (hereinafter "DPO"), who can be contacted by phone at 12 663 12 25 or by e-mail: iod@uj.edu.pl. (3) The DPO can be contacted in any matter regarding the processing of your personal data. (4) The processing of personal data at the Jagiellonian University takes place in order to perform legal and statutory tasks. The basic scope of activity of the Jagiellonian University includes: educating undergraduate and graduate students, doctoral students, and non-degree post-diploma students, conducting research and development, carrying out scientific research projects, providing research services as well as technology transfer, including educating and promoting research personnel. (5) The Jagiellonian University makes personal data available to entities authorized to receive it under applicable law and to entities cooperating and providing services to the Jagiellonian University, on the basis of concluded entrustment agreements. (6) Your personal data will be processed for the period specified in the provisions of applicable law or for the duration of the contract (including reciprocal settlements and for the period necessary to establish and pursue its own claims or to defend itself against claims brought by the other party(ies) and for the period of archiving the documentation) or in the case of processing data based on your consent - until the withdrawal of such consent. (7) Your personal data, processed by the Jagiellonian University, will not be subject to automated decision-making or profiling. (8) You have the right: to obtain information about the processing of personal data and rights under the GDPR, to access and rectify your data, as well as the right to delete personal data from the administrator's files (unless further processing is necessary to fulfill legal obligations or to establish, assert or defend claims), and the right to restrict processing, the right to data portability, the right to object to processing - in the cases and under the conditions specified in the GDPR. (9) In order to exercise the above-mentioned rights, an application should be submitted in writing to the Data Protection Officer at the following address: Jagiellonian University, ul. Gołębia 24, 31-007 Krakow or emailed to: iod@uj.edu.pl. (10) You have the right to lodge a complaint with the President of the Personal Data Protection Office if you believe that the processing of your personal data violates the provisions of the GDPR.

I confirm that I have read and accepted the information above.

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