Ciencia sem fronteiras

Science without Borders Flanders
Application form for Undergraduate students
Academic year 2013-14

Personal details last name | | first name(s) | | date of birth (dd/mm/yy) | | gender | male | | female | | | email | | address | | postal code | | city | | telephone | | passport number | | passport date of issue (dd/mm/yy) | | passport place of issue | | passport expiry date (dd/mm/yy) | |
Please submit a copy of your passport

Education

Home institution name of home institution | | current study programme | | current major | | study start date (dd/mm/yy) | | expected graduation date (dd/mm/yy) | | number of ECTS already awarded | | academic awards | | name of contact person at home institution | | position | | email address | | telephone number | |
Please submit a transcript of records, and your acquired diploma(s) if applicable.

English language scores

type of English language test taken | | date test taken (dd/mm/yy) | | overall score | | writing | | reading | | listening | | speaking | |
Please submit your official English language test results

Choice of Host University or University College

Please use the links to the Flemish universities and university colleges, and/or the link to the Study in Flanders search engine (http://www.studyinflanders.be/en/study-programmes/ ) to identify an institution and department where you would like to study.
Please provide details of the Flemish institution you have already established contact with, and the details of the contact person with whom you have discussed your study programme.

My choice of institution name of university or university college | | department | | study programme | | contact person name | | email | | telephone number | |

Motivation – Please motivate your choice |

Optional second choice name of university or university college | | department |