Faculty of Arts and Social Sciences

APPLICATION FORM

European Programme on Society, Science and Technology

ESST

MASTER PROGRAMME

AT MAASTRICHT UNIVERSITY

Application form UM master programme

Please read the instructions carefully before completing the form

A PERSONAL INFORMATION

(Please enclose a photocopy of your valid passport)

1. Names

Last name______First name ______

Middle name(s) ______Prefer to be called ______

2. Gender: c Female c Male 3. Date of birth (day/month/year) ______/______/______

4. Place of birth: City ______Country ______

5. Nationality ______

B AdDRESS(es)

6. Mailing address (This address will be used for all admission correspondence)

Number and street ______

City ______Postal (Zip) Code ______

Country ______

Telephone ______E-mail address ______

7. Permanent (home) address (if different from above)

Number and street ______

City ______Postal (Zip) Code ______

Country ______

Telephone ______Fax ______

C EducAtion

8. Educational institution you currently attend or have attended last:

Name ______

City______Country______

Date of entry (day/month/year) ______/______/______(Expected) date of graduation ______/______/______

9. Language of instruction at this institution ______

10. Name of the degree received or expected ______

11. Please include certified (bearing the seal of the institution and the signature of the Head or the Registrar) photocopies of your diploma and/or (if you have not yet graduated) the last transcript indicating subjects taken, and grades or credits earned.

12. Please include on a separate sheet a curriculum vitae, which gives an overview of your educational and professional experiences.

D Languages

13. What is your mother tongue? ______

14. English language proficiency:

Compulsory for non-native English speaking candidates: Please give your IELTS test score (academic) or TOEFL internet-based (iBT) score below, and include a copy of the results:

(a minimum IELTS score of 6.5 is required, and a minimum TOEFL iBT score of 90)

______

15. Other languages

Please indicate your proficiency in other languages using the following scale: native/good/reasonable/poor/none

Language / Years Studied / Speaking / Writing / Reading
Dutch
French
German
Spanish
Other
Other

E Motivation letter

16. Please explain on a separate sheet the motivation underlying your choice for the ESST Master programme at the Faculty of Arts and Social Sciences of Maastricht University. You may also wish to reflect upon a possible topic for your master thesis.

F ESSAY

17. Please write an essay of 1500–2000 words (5-7 pages and written in English) on a topic relevant to the interrelationship between society, science and technology.

g letters of recommendation

18.

Please include two typed (!) academic letters of recommendation in sealed envelopes. In the case of considerable work experience, employers’ letters of recommendation are acceptable.

H interdisciplinary interest

19. Please show evidence of interdisciplinary interest such as:

·  transcripts showing interdisciplinary course work;

·  CV showing evidence of interdisciplinary interest;

·  extra-professional or extra-curricular activities showing interdisciplinary interest.

I Other information AND FINANCIAL SUPPORT

20. How did you first learn about the ESST programme?

c Friends/Family c Website c UM student c School counsellor c Information fair c Advertisement

Please give details:

______

21. Financial support. How do you plan to finance your education?

c by myself (please note: non-EU students need a bank guarantee for the visa procedure)

c through my institute/employer

c I have obtained a fellowship

c I have applied for a fellowship from……………………………………………

22. Computer experience. Are you familiar with the use of computers and software?

Word for windows: Internet:

c yes c no c yes c no

Excel: E-mail:

c yes c no c yes c no

J Additional Information (OPTIONAL)

Please use this box for any additional information you would like the Board of Admission to take into consideration and you feel is not sufficiently reflected in this application. If you need additional space you can attach a separate sheet of paper that clearly states your name. Please try to be brief.

K Application Checklist

Please make sure you have done all of the following before sending in your application:

c Answered all questions on the application form

c Included a photocopy of your valid passport or EU ID-card total number of pages ______

c Included a certified copy of your bachelor certificate and list of grades total number of pages ______

c Included a copy of your IELTS/TOEFL iBT results (if applicable) total number of pages ______

c Included your motivation letter total number of pages ______

c Included two letters of recommendation total number of pages ______

c Included your essay total number of pages ______

c Included your evidence of interdisciplinary interest total number of pages ______

c Included your curriculum vitae total number of pages ______

c Signed the application form (with blue ink)

L Signature

I certify that all the statements I have made on this application form are correct and complete.

Date ______/______/______Signature ______

Please submit this application form and all supporting documents to the OSF Educational Advising Centre in your home country by 4 February 2013. Please ensure that you also apply online via Studielink (www.studielink.nl) + the My UM portal, where you must upload all required documents, except this application form.

CONFIDENTIALITY

Maastricht UNIVERSITY will treat all applications with the greatest confidentiality

Application Form Maastricht University for entry in September 2013 page 4 out of 7