| | Kommunala Vuxenutbildningen |
| Svenska för invandrare - Swedish for immigrants | |
| Dagens datum/Today´s date: | |
| Namn/Name: | |
| Personnummer/Personal number: | |
| Adress/Address: | |
| Lägenhetsnummer/Apartment number: | |
| C/O: | |
| Postnr/Zipcode: | |
| Ort/Town: | |
| Telefon/Telephone: | |
| E-mail: | |
| Nationalitet/Nationality: | |
| Modersmål/Language: | |
| Övriga språk/Other languages: | |
| Behövs tolk/Interpreter: | |
| Läst SFI tidigare/Previous study of SFI/Swedish: | |
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| SFI betyg/SFI certificate: | |
| Ort/Town: | |
| Datum/Date: | |
| Studerar på BTH/Student at BTH: | |
| Utbildning i hemlandet/Education in your homecountry (antal år totalt/total number of years): | |
| Inflyttad till/Arrival to Sverige/Sweden (vilket år/which year): | |
| Inflyttad till/Arrival to Karlskrona (vilket år/which year): | |
| Övrig information/Further information: | |
| Tillhör Etableringen/Belong to the Introduktion (Fylls i av myndigheterna/To be completed by the authorities): | |
| Handläggare/Administrator (Fylls i av myndigheterna/To be completed by the authorities): | |
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