faculty of theology and
religious studies
NL GRONING01
2012-2013
Erasmus
Exchange programme :
 Bilateral exchange programme
1. PERSONAL DETAILS
Family name: .......................................................
Current Address:
.............................................................................
Street ..................................................................
First name (s): ......................................................
Postal code: ........................................................
.............................................................................
City + Country:....................................................
Sex:
 Male
 Female
Phone Number: ..................................................
Date of birth:(dd/mm/yyyy)...................................
.............................................................................
Email address:....................................................
Nationality: ...........................................................
.............................................................................
Permanent Address (If different)
Place of Birth: ......................................................
Street: .................................................................
.............................................................................
Postal code: ........................................................
Do you have a disability or other special needs?
City + Country:....................................................
 yes
 no
Phone Number: ..................................................
(if yes, please give further details in section 4)
2. PROPOSED PROGRAMME OF STUDY
Name of your university: ......................................................................................................................
Erasmus institution code (only for Erasmus students) ........................................................................
Period of Study:
 semester 1
 semester 2
 full academic year
Number of years you have been studying in higher education: ..........................................................
Degree you are currently studying for: ................................................................................................
Subject area of the degree you are studying for at your home university:
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1›4
08.0 Theology & Religious Studies
08.3 History
08.4 Archaeology and Prehistory
08.9 American Studies
03.6 Art History
03.9 Arts, Culture & Media
09.1 English Language & Culture
09.1 German Language & Culture
09.1 Romance Languages & Cultures
09.3 General Linguistics
09.5 Classical Studies
09.6 Languages & Cultures of the Middle East
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09.8 Finno-Ugric Languages & Cultures
09.8 Frisian Language & Culture
09.8 Scandinavian Languages & Cultures
09.8 Slavic Languages & Cultures
14.6 International Relations & International
Organisation
 15.0 Communication & Information Studies
 15.9 Information Science/ Humanities computing
 Other: ...............................................................
.................................................................
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faculty of theology
and religious studies
NL GRONING01
2012-2013
3. LANGUAGE SKILLS
Mother tongue: .....................................................................................................................................
Language of instruction at your home institution: ................................................................................
Other languages
.................................
.................................
.................................
I am currently studying
this language
I have sufficient
knowledge to follow
lectures *
Yes
No
Yes
No
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I would have sufficient
knowledge to follow
lectures if I had some
extra preparation
Yes
No
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


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* If you tick yes here, then you need to specify this in section 4.
4. ADDITIONAL INFORMATION
(in this section, you can put additional information, e.g. about disabilities, language skills)
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5. DECLARATION OF THE SENDING INSTITUTION
(to be filled in by the departmental coordinator)
I hereby confirm that
Mr / Mrs. ............................................................................................................ (name of applicant)
is enrolled for (subject) ..........................................................................................at our institution.
He / she is nominated as an Erasmus-exchange student at your institution for the duration of
............................................................................................................................................. months
I also confirm that he / she has sufficient knowledge of the Dutch or English language to be able to
take courses at your university.
2›4
faculty of theology
and religious studies
NL GRONING01
2012-2013
Name of the departmental coordinator: ...........................................................................................
Email address: .................................................................................................................................
..........................................
................................................
.....................................................
date
signature
stamp of the institution
6. STUDENTS DECLARATION
I certify that the information given in this application is correct and complete. I have filled in all the
requested information and enclosed all necessary documents for my application.
..........................................
................................................
.....................................................
date
signature
stamp of the institution
7. STUDENT CHECKLIST
For your application you need to send the following documents:
 Letter from your home university confirming that you have been selected to participate in
the exchange programme
 Application form for international students (1 original, 1 copy)
 Learning Agreement
 Transcript of records
 1 copy of your passport
 2 passport pictures
 1 copy of your health insurance
 Motivation letter in English (300 words)
 English language certificate, or letter from your University indicating that your English is
sufficient (indication of language proficiency required to study successfully are TOEFL
scores 637 (paper), 270 (computer) or 110 (internet) or a minimum score of 7.5 in IELTS
You need to return these documents all together to:
International Office
Faculty of Theology and Religious Studies
Oude Boteringestraat 38
9712 GK Groningen
The Netherlands
Incomplete applications cannot be processed
Deadlines for application:
15 June for the 1st semester and full academic year, 15 December for the 2nd semester
3›4
faculty of theology
and religious studies
NL GRONING01
2012-2013
8. INFORMATION TO BE COMPLETED BY THE RECEIVING INSTITUTION
We hereby acknowledge receipt of the application.
The above mentioned student is
 provisionally accepted at our institution
 not accepted at our institution
Departmental coordinator
Institutional coordinator’s
Name: .................................................................... Name: ...................................................................
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..................................... ....................................... ......................................
....................................
date
signature
signature
date