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APPLICATION FORM 2005/2006

FOR EXCHANGE STUDENTS

1)   Personal Data

Family name                          ...................................................................................……..

First name(s)                         .............................................................……     male/female

Current address                    ..................................................................­...........................

Postal Code & City                ..................................................................­............................

Country                                  ..................................................................­............................  

Home telephone                    ..................................................................­............................

E-mail address                      ..................................................................­...... (important!)

Date and Place of birth          .................................. (dd/mm/yy)          ................................….

Nationality                                .................................................­......

Marital status                         .................................................­......

2)    Current Education

Name of institution                 ..................................................................­............................

Department                            ..................................................................­............................

Country                                  ..................................................................­............................

Contact person                      ..................................................................­............................

For how many years have you been enrolled at this institu­tion and how many

semesters have you completed thus far?

..................................................................­............................

3)    Which programme are you going to attend in Groningen? (please circle)

·       International Business School

·       School Communication & Media

·         Creating Communication Campaigns

·         EPIC (European Perspectives on International Information and Communication)

·       School of Facility Management

·       School of Marketing & Management

·         International Business and Languages

·         Small Business & Retail

·         Export Management

·         Food & Business

4)        Type of exchange programme (please circle)

·        ERASMUS

·         Bilateral

5)        For which study period do you wish to be enrolled? (please circle)

·       Autumn semester (September 2005- January 2006)

·       Spring semester (February 2006 - July 2006)

·       Whole academic year (September 2005 - July 2006)

Note: If you are a Double Degree student, you should not use this form!

6)        Does your nationality require entry into The Netherlands with a visa?

More info at http://www.nuffic.nl/immigration/start/which.htm

·       No

·       Yes (please complete our Visa Assistance Form)

7)        Housing

Do you need assistance in finding a room in Groningen?

·       No

·       Yes (please complete an application form at www.housingoffice.nl)

You need to pay a mediation fee of Euro 55 and send proof of your bank transfer together with your application. Banking details:

Beneficiary:                   Hanze University Groningen

Bank account:               48.95.79.256

Bank:                            ABN/AMRO, Stationsweg 1, 9726 AC Groningen, The Netherlands

Swift code:                    ABNANL2A

IBAN-number:                NL59 ABNA 0489579256

Description:                   Student name, study department & “housing 7BI17/B20”

8)        Insurance

Does your current insurance provide coverage during your stay in The Netherlands? More info:  http://www.nuffic.nl/pdf/service/factsh/health-insurance.pdf

·       Yes

·       No, if you wish to purchase an Insurance Passport for Students through Hanze University Groningen, please contact us immediately upon arrival.

More info: http://www.ace-ips-nl.com/.

Include with your application:

·         a copy of your passport

·         3 passport size photos

·         housing application form

·         proof of payment of Euro 55

·         Visa Assistance Form (if you need a visa)

Deadline Autumn 2005:  1 June 2005

Deadline Spring 2006:    1 November 2005

Contact persons ISO:

Corine Venema           c.d.venema@pl.hanze.nl        +31-50-5954032

Janine Brons               j.l.brons@pl.hanze.nl              +31-50-5954031

Fax # +31-50-5954999

Please return your application to the following address:

Hanze University Groningen

International Student Office

PO Box 3037

9701 DA Groningen

The Netherlands

www.hanze.nl

As soon as your application has been received, you will be sent more information on subject choices at Hanze University Groningen!

To be filled out by Hanze University Groningen