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?
 *
Are you currently residing in Belgium as a 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
Do you already have a University of Antwerp account (as a student or staff member)?
 *
Attention! Please note that your application is not complete yet. Filling out this form was just the first step. Please check your email to find out the further guidelines to complete your application before the deadline. Don't forget to check your spam folder in case you haven't received a message. Please contact summeruniversity@uantwerp.be if you have any questions.
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