APPLICATION FORM AMSTERDAM MERIT SCHOLARSHIP (AMS)

FIRST NAME(S): ___________________________________________________________________________

FAMILY NAME: ____________________________________________________________________________
GENDER: O FEMALE O MALE
DATE OF BIRTH (DD/MM/YYYY):______________________________________________________________
COUNTRY AND PLACE OF BIRTH:______________________________________________________________
NATIONALITY: ____________________________________________________________________________
PHONE NUMBER (INCLUDING COUNTRY CODE):_________________________________________________
E-MAIL: _________________________________________________________________________________
I HAVE APPLIED FOR THE BACHELOR’S IN COMMUNICATION SCIENCE
UVA STUDENTNUMBER: __________________________________________________________________

CURRENT/MOST RECENT EDUCATION:

TITLE OF DEGREE CERTIFICATE/DIPLOMA (IN ORIGINAL LANGUAGE): ________________________________

NAME OF INSTITUTE: _______________________________________________________________________
ATTENDED FROM (day/month/year): __________________________________________________________
DATE OF (expected) GRADUATION: ___________________________________________________________
GPA (as stated in the grade list): _______________
FINAL (or predicted) GRADE FOR
ENGLISH: _________
MATHEMATICS: _________

CHECKLIST Please check the documents included in your application, and please sort in this order:
 Application form Amsterdam Merit Scholarship (this form)
 Application letter Amsterdam Merit Scholarship
 Proof of belonging to the top 10% of your class; a statement that indicates your ranking. This
statement is only accepted if it is signed by the examinations board or dean
 Copies of diplomas (if obtained) AND grade transcripts (including a certified translation if the language
is any other than Dutch, English, German or French
 English language test score (may be sent directly to us by the testing organization)
 Curriculum vitae
 Description of extracurricular activities
Comments to the checklist (please clarify if one or more of the requested documents are not included):

___________________________________________________________________________________________
DECLARATION AND SIGNATURE:
I declare that the information provided by me is correct and complete. I understand that incomplete
information will delay the application process and I accept that incorrect information will render the
application invalid. I authorise the Admission’s Office to verify my documents.

DATE: (day/month/year): _______________PLACE & COUNTRY: _____________________________________

SIGNATURE: _______________________________________________________________________________

Please send your AMS application to:

College of Communication
Admissions Office (C7.02)
Postbus 15796
1001 NG Amsterdam
The Netherlands

Please note: You are only eligible for the Amsterdam Merit Scholarship if you have been accepted to the
Bachelor’s programme in Communication Science. Therefore we advise you to apply for the AMS and the
programme simultaneously (before 15 January 2020). More information on how to apply for the Bachelor’s
programme can be found on our website. Incomplete applications will not be taken into consideration.

Thank you for your application. We will confirm the receipt of your application materials via e-mail as soon as
they arrive.

Please print this form two-sided