Bureau Internationale Studentenzaken
International Student Affairs
APPLICATION FORM
Name home university:
Name Exchange Coordinator:
E-mail address:
Telephone number:
Requested period of exchange
From:
/
(month/year)
Till:
/
(month/year)
Personal Data:
Last Name:
Given names:
First name (if different from given name):
Nationality:
Gender:
Male
Female
Place of birth:
Date of birth:
/
/
(day / month / year)
Country of birth:
Passport number:
Valid until:
Address:
Postal code:
City:
Telephone number:
Mobile number:
E-mail address:
2nd e-mail address:
Emergency contact:
Name:
Relationship:
Address:
Postal code:
City:
Telephone number:
Mobile number:
E-mail address:
Educational background:
Field of study:
Specialization:
Year of study completed:
Expected date of graduation:
November 2009
Bureau Internationale Studentenzaken
International Student Affairs
Requested faculty/department at UvA:
____ International School of Humanities and Social Science (ISHSS)
____ Faculty of Humanities
____ Amsterdam Law School
____ Faculty of Business & Economics
____ Department of Psychology
____ Other, namely:
Study Plan:
List of courses you would like to take at the host university:
Course title (incl. code)
/
# of (local) credits
1.
2.
3.
4.
5.
6.
7.
Other study or research plans (describe on a separate sheet of paper if necessary):
Proficiency in English for Non-Native Speakers
Poor (-)
Weak (+/-)
Average (+)
Good (++)
Speaking
Writing
Reading
TOEFL-score:
IELTS -score
Other relevant information for your application ( restrictions, medical information, etc.):
Date:
/
/
(day / month / year)
Place:
Signature: Sign this form after printing
November 2009
Bureau Internationale Studentenzaken
International Student Affairs
Do not forget to include the following:
1. Two recent passport photo with your name on the back
2. Certified photocopies of all academic records: an official 'transcript' or list of courses/examinations
taken and grades obtained, including a list of courses in progress.
3. A proof of English language proficiency; like TOEFL (score 230 CB or 88/89 IbT) or IELTS (score 6,5),
for non-native speakers only. Scores can be sent separately.
4. Letter of motivation in which you state the reason why you wish to attend the programme (approx. 400500 words)
5. Curriculum vitae (resume)
6. Academic letter of reference (by a member of staff at the applicant's home university)
7. A copy of your passport (identity-page) or identity card
8. Please enclose an extra copy of the complete original file!!!
CHECKLIST :

Application Form (with photo)

Motivation letter

Curriculum Vitae (resume)

Certified copies of academic records

Letter of reference

Copy of passport

Proof of English language proficiency

Extra copy of the complete file
Application deadline:
Full Year & Semester 1:
Semester 2:
April 1
September 15
Application files have to be sent by the exchange coordinators of the home university to:
University of Amsterdam
Attn. Ingeborg de Brieder
International Student Affairs
Binnengasthuisstraat 9
1012 ZA Amsterdam
The Netherlands
November 2009