C Skjema Engelsk 3p442w

Documentation of academic progress and tuition fees

C English

1 Personal information To be filled in by the student Customer number in Lånekassen

Date of birth and personal ID no. (11 digits)

Surname

First name and middle name

2 Information about academic progress and tuition fees To be filled in by the educational institution a) Full name of educational institution b) Full name of academic programme c) The student’s level/year/semester of study during the period 1 Jan. 2011 – 31 Dec. 2011 (or to this date)

□ Yes

□ No

e) Has the student attended full-time studies (100 % study load) during the period mentioned in c)?

□ Yes

□ No

f) Did the student pay tuition fee for the period 15 Aug. 2011 to 15 June 2012? If yes, please state the full amount of tuition fee paid (including mandatory fees)

□ Yes

□ No

d) Has the student achieved standard academic progress during the period mentioned in c)? If no, please provide details about  exams the student has failed or postponed  estimated completion date of current academic programme (mm/yy) Please enclose academic transcript

Amount and currency

3 Signature and stamp of the educational institution I/We declare that the information provided is correct. Place/date

Signature

Stamp

For further information about The State Educational Loan Fund (Lånekassen), please consult our website at lanekassen.no/English. For the student, please send this form in original to: Lånekassen, Postboks 36 Kalbakken, N-0901 Oslo, Norway Form C – Article Number 9001555 – English – 02.2012