Application form of the University of Antwerp
All fields marked with a (*) must be filled in.
Application Details
Type of applicant
 *
Type of person
 *
Exchange Programme *
Academic year *
Personal details
Family name *
First name *
Other First Names
Gender
 *
Date of birth (dd.mm.yy) *
Country of birth *
Place of Birth *
Nationality *
Other nationality?
E-mail address *
Same e-mail-address for verification *
Information about contact person in case of emergency
Last name *
First name *
E-mail address *
Telephone number *
Dit veld mag niet met een nul beginnen. Gebruik een '+'. Bv. '02 333 44 55' wordt '+23334455'.
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This field may not start with a zero. Use a '+'. For instance. '02 333 44 55' becomes '+23334455'.
Type of relationship to student *
Educational Background
Are you currently a student?
 *
What is your current job? *
Currently employed at *

Previously obtained degree (relevant to the summer school)
Name of the degree
Institution
Name of the degree
Faculty
Date of graduation

Previous Work Experience (relevant to the summer school)
Company / Institute
Antwerp Summer University
Country of Host Instititution *
Host Institution *
Summer School *
Where did you hear from this summer school? *
Do you need a visa to come to Belgium?
 *
Do you wish to apply for a reduced registration fee as a recognized refugee?
 *
Dietary requirements
Vegetarian
 *
Vegan
 *
Gluten free
 *
Other
Declaration
I confirm that the information I have given above is correct to the best of my knowledge.  *
The University of Antwerp (summeruniversity@uantwerpen.be) collects these data for your registration at the university. These data will not be shared with third parties. More info on our privacy policy: www.uantwerpen.be/disclaimeren
Are you currently registered as a student at the University of Antwerp?
 *
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