| Personal data
|
|
 |
Last name |
|
|
|
|
First names |
|
|
|
|
Gender |
|
|
|
|
Place of birth |
|
|
|
|
Date of birth |
|
|
|
|
|
|
|
Nationality |
|
|
|
| Current address
|
|
|
Address |
|
|
|
|
Housenumber |
|
|
|
|
City and postal code |
|
|
|
|
Country |
|
|
|
|
Telephone |
|
|
|
|
Email adres* |
|
|
|
| Permanent address (if different)
|
|
|
Address |
|
|
|
|
Housenumber |
|
|
|
|
City and postal code |
|
|
|
|
Country |
|
|
|
|
Telephone |
|
|
|
|
E-mail |
|
|
|
|
I allow the office for international relations to pass on my personal (email) address to the co-ordinator of the appropriate Faculty and the Erasmus Student Network Utrecht |
|
|
|
| Study information
|
|
|
Proposed field of study at the Utrecht School of the Arts |
|
|
|
|
Proposed period of study |
|
|
|
|
Number of expected ECTS- credits at the Utrecht School of the Arts |
|
|
|
|
Sending institution |
|
|
|
| Previous and Present Education
|
|
|
Diploma/degree for which you are currently studying |
|
|
|
|
In which year did you start your present art education ? |
|
|
|
|
Have you already studied abroad? |
|
|
|
|
If yes, when and where did you study ? |
|
|
|
|
Exchange Programme |
|
|
|
|
add 1) Other... |
|
|
|
|
How are you going to finance your stay in Utrecht? |
|
|
|
|
add 1) Grant called |
|
|
|
|
add 2) Further detail |
|
|
|
| Language skills
|
|
|
Native language |
|
|
|
|
Other languages |
|
|
|
|
How is your Dutch ? |
|
|
|
|
How is your English ? |
|
|
|
| Work experience related to current study (if relevant)
|
|
|
Type of work experience |
|
|
|
|
Firm/organisation |
|
|
|
|
From / to |
|
|
|
|
Country |
|
|
|
|
Further relevant information (special medical conditions, etc.) |
|
|
|
