Questionnaire

The Appendix 1

Questionnaire
participant of International Student Olympiad
from Safety of living

1. Name, last name (fully) ________________________________________

2. Date of birth _________________________________________________

3. Country _____________________________________________________ 
4. Higher educational establishment (the complete name and address) ____
____________________________________________________________

5. Faculty, course _______________________________________________

6. By the decision of organizational committee _______________________ 

(The name of higher educational establishment)

student____________________________________________________ 

( name, last name)

which in the ІI stage of olympiad _____________________________(only for students from Ukraine)
(The name of olympiad from educational discipline, specialities (straight)

occupied______ place,

is recommended to participation at the International student Olympiad

Chairman of organizational 
committee
higher educational establishment ____________ ____________________
(Signature) (The last name, name)

Signature of participant of olympiad ______________________________

Date of filling ________________________________________________