Science without Borders Flanders

Application form for Undergraduate students

Academic year 2015-16

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 ofcontact 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 ( ) 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.

Myfirst choice of institution

name of university or university college
department
study programme
contact person name
email
telephone number

Motivation – Please motivate your choice

Mysecond choice of institution

name of university or university college
department
study programme
contact person name
email
telephone number

Motivation – Please motivate your choice

Certification of authenticity

I hereby certify on my honor that the information provided in this application is correct and complete. Any provision of inaccurate or false information or omission of information will render this application invalid and that, if selected on the basis of such information, I can be required to withdraw from the award.

date of submission
signature of applicant
signature of contact person at home institution
official stamp of home institution

** Authorized signature and official stamp are required after selection is made. There is no need for signature and stamp during application procedure.

Please send the completed form to by 2nd March 2015.

The form should be renamed with your last name and date of birth

(surname_ddmmyy).

Please add the following documents:

-copy of passport

-official English language test results

-transcript of records

-acquired diploma(s), if applicable