Please

attach
original
4 passport
size
pictures
here

Application form Spring 2011 EXCHANGE students

Only ORIGINAL (hardcopy) forms completed on a computer in print letters including all
attachments and signatures are accepted

1. Personal details (passport details)

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

First name(s): ………………………………………………………………….
Date of birth: ..……………………………………………………….............(dd/mm/yyyy)
Place and Country of birth: …………………………………………………………………..
Nationality: ……………………………..……………………………………
Gender:  Female  Male
2. Contact details (permanent address)
Street: ……………………………………………………………………
Postal code: ……………………………………………………………………
City: ……………………………………………………………………
Country: ……………………………………………………………………
Telephone: ……………………………………………………………………
E-mail: …………………………………………………………………..
3. Contact details home university
Name of University: …………………………………………………………………….
Study Area: …………………………………………………………………….
Current Year of study: 1/2/3/4/5
Contact person: …………………………………………………………………….
E-mail: …………………………………………………………………….
Address: …………………………………………………………………….
Country: …………………………………………………………………….
Erasmus Identity code: …………………………………………………………………….

4. Enrolment details Applying for study area:

O International Services Management (IBB) O Logistics and Transport Management (IBB)

O Architecture (IBB)
O International Business Experience (IBEX) O International Business and Career (IBaC)
O Primary Education (IVL PABO) O Secondary education (IVL LERO)
O International Business & Management Studies (RBS) O International Business & Languages (RBS)
O Business Graduate (RBS)
O Pre-IBMS (RBS)
O International Class 3 months (Bridging Cultures in Multicultural Rotterdam))
o School of Education, primary education (PABO)
o School of Education, secondary education (LERO)
o School of Social Work (ISO)
O International Class 5 months ( Bridging Cultures in Multicultural Rotterdam)
o School of Education, primary education (PABO)
o School of Education, secondary education (LERO)
o School of Social Work (ISO)

O Other, please specify:….

Semester:  Spring 2011  Fall 2011  Both semesters
5. Visa

Will you be needing a VISA? YES NO

6. Insurance

Will you be insured during your stay in the Netherlands? YES NO

If so, please State name of insurance company ………………………………………………

7. Scholarship

Will you be coming over as an exchange student on a scholarship? YES NO

If so, please state name of scholarship ………..………………………………………………

8. Housing

Will you be staying in the housing offered by Rotterdam University YES* NO

* Please fill in the housing forms and send them to the Student Housing Office (studenthousingoffice@HRO.nl)

9. Checklist (please attach the following documents, without these documents the application is invalid)

o Transcript of records

o A copy of your passport

o A copy of your birth certificate in English (needed for registration at municipality)

o Motivation Letter

o Resume in English

o Three passport sized pictures

Only ORIGINAL (hardcopy) forms completed on a computer in print letters including all
attachments and signatures are accepted

10. Signature sending institution

Place Date

…………………………………………… ………………………………………….

Signature of the student

………………………………………………………………………………………………………

Signature and stamp of sending institution:

With this signature we confirm that the above-mentioned student meets the requirements of Rotterdam University.

Departmental co-ordinator’s signature Institutional co-ordinator’s signature

………………………………………… …………………………………………
………………………………………… …………………………………………

Date:………………………………….. Date:…………………………………
Name:………………………………… Name:……………………………….
 This form should be returned to:
Hogeschool Rotterdam/Rotterdam University
International Office, room K.O2.224
Kralingse Zoom 91, 3063 ND Rotterdam
the Netherlands

Tel: +31 10 794 6005

Fax: +31 10 794 6007
E-mail: internationaloffice@hro.nl

Deadlines:
Fall semester (or one academic year) May 1st
Spring semester November 1st