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APPLICATION FORM

ADMISSION PROCEDURE FOR STUDENTS with a FOREIGN DIPLOMA


Send this form with all the required documents (see http://www.ua.ac.be/ENGLISH&n=33427) to: Mrs Carla Dinnewet, University of Antwerp, Central student administration, City campus, Building S, Lange St. Annastraat 7, B-2000 Antwerp - Belgium.

1.

PERSONAL DATA First name:

Surname: Place of birth (city, country): Date of birth (DD-MM-YYYY): Nationality: 2. OFFICIAL RESIDENCE

Male /

Female

Street: Postal code: Country: Telephone: Address in Belgium (if applicable): 3. E-mail:

Number: City, Province:

INFORMATION REGARDING THE APPLICATION

Please consult the website of the university regarding the programs offered: http://www.ua.ac.be/ENGLISH&n=42712

I wish to enroll in the following program during the academic year Select O Bachelor program: O Master or Advanced Master program (only for holders of a Bachelor/Master degree):

Date:

Signature applicant,

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