Čestné vyhlásenie študenta o štúdiu na vysokých školách/STATUTORY DECLARATION about students higher-education studies in the Slovak Republic (only for students who are not citizens or permanent residents of the Slovak Republic)
pre akademický rok/for academic year ........................

Titul, meno a priezvisko/Title, name, surname:	Fakulta (ústav)/Faculty (Institute): .....................................................................................................	.............................................................................................................
ID/Student ID No.: ......................................................................	Stupeň štúdia/Degree level: 	□ 1. stupeň/1st (bachelors)
Dátum narodenia/Date of birth: .................................................		□ 2. stupeň/2nd (engineers, masters)
Miesto narodenia/Place of birth: ................................................		□ 3. stupeň/3rd (PhD.)
.....................................................................................................	Forma/Form of study:
Trvalé bydlisko/Permanent residence: .......................................		□ denná/full-time	□ prezenčná/presence
.....................................................................................................					□ dištančná/distance
.....................................................................................................					□ kombinovaná/combined
.....................................................................................................		□ externá/external
Študijný program/Study programme: .........................................	Jazyk štúdia/Language of instruction:	□ slovenský/Slovak
………………………………………………………………………………………..						□ cudzí/foreign

Okrem uvedeného štúdia/Except for above stated study: 
□  nie som zapísaný/á, ani som nebol/a zapísaný/á na vysokoškolské štúdium na STU alebo inej vysokej škole v SR./I am not enrolled or have never been enrolled in any higher education study at STU or other higher education study in the Slovak Republic.

□  som zapísaný/á alebo som bol/a zapísaný/á na vysokoškolské štúdium na STU alebo inej vysokej škole v SR. Túto skutočnosť uvádzam nasledovne:/I am enrolled or I was enrolled in a higher education study at STU or other higher education study in the Slovak Republic. I am stating it as follows:

Iné štúdium 1: VŠ, fakulta/1st other study: Higher education institution, faculty: 

	Zápisy do akad. rokov/ Enrolment dates in every academic year	Školné platil/a – neplatil/a
Tuition fee paid – fee not paid2	
Stupeň štúdia/Degree level:
□ 1. stupeň/1st (bachelors)
□ 2. stupeň/2nd (engineers, masters)
□ spojený 1. a 2. stupeň/1st & 2nd degree together as one unit
□ 3. stupeň/3rd (PhD.)	
................./ ................
................./ ................
................./ ................
................./ ................
................./ ................
................./ ................	
.............................................
.............................................
.............................................
.............................................
.............................................
.............................................	
Jazyk štúdia/Language of instruction1:   □ slovenský/Slovak
                                                                       □ cudzí/foreign			
Forma/Form of study: 
□ denná/full-time   □ prezenčná/presence
                                   □ dištančná/distance
                                   □ kombinovaná/combined 
□ externá/external			
Študijný program/Study programme: 
	Dátum začiatku štúdia/Study start date:
Dátum skončenia štúdia/Study end date:	

Iné štúdium 2: VŠ, fakulta/2nd other study: Higher education institution, faculty:

	Zápisy do akad. rokov/ Enrolment dates in every academic year	Školné platil/a – neplatil/a2
Tuition fee paid – fee not paid2	
Stupeň štúdia/Degree level:
□ 1. stupeň/1st (bachelors)
□ 2. stupeň/2nd (engineers, masters)
□ spojený 1. a 2. stupeň/1st & 2nd degree together as one unit
□ 3. stupeň/3rd (PhD.)	
................./ ................
................./ ................
................./ ................
................./ ................
................./ ................
................./ ................	
.............................................
.............................................
.............................................
.............................................
.............................................
.............................................	
Jazyk štúdia/Language of instruction1:   □ slovenský/Slovak
                                                                       □ cudzí/foreign			
Forma/Form of study: 
□ denná/full-time   □ prezenčná/presence
                                   □ dištančná/distance
                                   □ kombinovaná/combined 
□ externá/external			
Študijný program/Study programme: 
	Dátum začiatku štúdia/Study start date:
Dátum skončenia štúdia/Study end date:	

V zmysle § 71 ods. 3 písm. b) Zákona č. 131/2002 Z.z. o vysokých školách a o zmene a doplnení niektorých zákonov v znení neskorších predpisov a čl. 28 bod 4 písm. c) Študijného poriadku STU vyplnené a podpísané tlačivo študent odovzdáva na študijnom oddelení pri zápise na štúdium a pri zápise do ďalšej časti študijného programu./Pursuant to Article 71, Section 3, letter b) of Act No. 131/2002 Coll. on Universities and on amendments and supplements to certain laws, as amended, and to Article 28, point 4, letter c) of the Code of Studies of the STU, student hands dully-filled and signed declaration to the Study department at his/her enrolment in studies and at his/her enrolment in further part of the study programme.

Vyhlasujem a svojim podpisom potvrdzujem, že uvedené údaje sú pravdivé a nezamlčal/a som žiadne ďalšie vysokoškolské štúdium/I hereby declare and confirm with my signature that above information is true and that I have not hidden any information regarding my other higher-education studies.

Bratislava/Trnava dňa/on: ....................................	..............................................
        podpis študenta/students signature