Instructions

  1. Please use the computer to fill in this form. We cannot accept handwritten forms.
  2. Print the first page, sign it and send it back as a digital copy
  3. Safe the scanned file with your family name first.

PERSONAL DETAILS
First name
Family name
Student number / S
Study programme at Leiden University
INTERNSHIP DETAILS
Name company / organization
City and country
Period of your internship
(from – until)

Conditions and requirements

A.

  1. You are enrolled as a degree seeking student at the Faculty of Humanities, Leiden University;
  2. Your internship is a full-time position;
  3. Your internship plan has been signed by all parties;
  4. Your internship agreement has been signed by all parties (if applicable);
  5. Your internship will take place outside the European Union , Turkey, Iceland, Liechtenstein, and Norway.
  6. The Dutch Ministry of Foreign Affairs does not advise against all but essential travel, nor does it advise against all travel to the concerning country / area.
  7. You did not receive this scholarship during your current degree programme;
  8. You are not applying for any other Leiden University grant (e.g. LUSTRA+);
  9. You application for the scholarship has reached the 2 weeks (10 working days) before the start of your internship;

B.

  1. The scholarship will be paid once it is established that you have met all requirements;
  2. Inform yourinternship coordinator as soon as possible in caseyour internshiphas tobe cancelled or has been interrupted;
  3. Ifyour internship has tobe cancelled or has been interrupted, the Faculty of Humanities maydecide how much of your scholarship will be claimed back.
  4. In case of examination fraud or other forms of misconduct,the Faculty of Humanities may decide how much of your scholarship will be claimed back.

C.

Your scholarship is a single award intended for the sole purpose of funding your internship. Leiden University is required to declare this scholarship to the Dutch tax authorities. Leiden University cannot be held responsible for any consequences resulting from this tax declaration. You are advised to contact the Dutch tax authorities for more information on this matter.

The undersigned declares that:

-he/she has read and understood the conditions and meets the requirements as stipulated above.

Name:

Signature:

City: Date: / /

Aanvraagformulier beurs Stagefonds Geesteswetenschappen, versie januari 2016 volgens het besluit van het faculteitsbestuur d.d. March 2016

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