Application form 2011 / 2012

1. PERSONAL INFORMATION
Personal record
Sur-/Family name :
First/Given name :
Date of birth : (dd / mm / yyyy) Place of birth :
Nationality :
Gender :  Male  Female Marital status :  Single  Married
Personal address
Address :

Postal code :
City :
State or Province :
Country :
Telephone
:
number
Fax number :
E-mail address :
Parents / guardians / legal representatives
We need your parents’/guardians’/legal representatives’ signature and address if you are younger than 18 years of age.
Do you live with your parents / guardians / legal representatives?
 Yes  No (if Yes, you don’t have to fill in the address below.)
Name :
Address :

Postal code :
City :
State or Province :
Country :
Telephone
:
number
Passport details
Passport number :
Place of issue :
Date of issue :
Expiry date :

Agent/partner information
Are you applying for a course at Saxion University individually or through an agent/partner?
 Individually
 Through an agent/partner
(Please fill in the name and e-mail address of the agent/partner below.)
Name :
E-mail address :
Application form 2011 / 2012

2. COURSE APPLICATION
Please tick the course you wish to apply for:
Preparatory courses
 Prep. Year  Prep. Semester  Prep. Short Track  Intensive Prep. Course  Foundation Summer Course
(If you apply for a Preparatory course in ’11/ ’12 it is compulsory to tick a Bachelor or Master course you wish to apply for in ‘12/’13 )

Bachelor courses
4- Year bachelor courses
 Art & Technology (34713)  Hotel Management (34411)
 Electrical & Electronic Engineering (34267)  International Finance & Accounting (-)
 International Business & Management studies (34936)  Physiotherapy (34570)
Located at:  Enschede  Deventer  Tourism Management (34410)
(Tick only when you prefer a location and only for International Business & Management Studies)

Final year courses

 Accounting, Finance & Control (34401)  International Business & Law (-)
 Art & Technology (34713)  International Law (-)
 Business Engineering (-)  Leadership in Social Work (-)
 Business Information Technology (34404)  Marketing (34402)
 Civil Engineering (34279)  Public Management & International Law (-)
 Entrepreneurship (-)  Textile Engineering & Management (34255)
 Environmental Science (34284)  Tourism Management (34410)
 Hotel Management (34411)  Urban Design (34282)
 Human Resource Management (-)  Urban & Regional Planning (34282)
 Information Services & Management (34649)
Master courses
 Master in Business Administration (MBA)  Master in Management (MA)
 MSc in Facility Management  MSc in Real Estate Management
 MSc in Environmental Science  MSc in Nature Conversation & Biodiversity Management
 MSc in Urban & Regional Planning
Short courses
 Environmental Impact Assessment  Sustainable International Business
 Integral Water Management  Urban Design
 International Business & Management

3 & 4. COURSE MOTIVATION & EDUCATIONAL BACKGROUND

Please write down your course motivation and educational background on a separate sheet of paper.
 I have attached my course motivation and educational background to my file.
Highest education completed :  High school  Bachelor
 2 or 3 years college/university  Master
Name of high school / college / university where the last study has been com pleted:

Name of the institution / departm ent :

Major in :
Application form 2011 / 2012

5. ENGLISH LANGUAGE PROFICIENCY

Please state your English language proficiency
 English is my native language or my previous education was taught in English*.
 English is not my native language.
 I have already taken an English language test
 IELTS, score:
 TOEFL, score:
 Internet based  Computer based  Paper based  NESO Indonesia
 Other test
Name: Score:
 I have not yet taken an English language test
* Saxion will always check your English language proficiency. Being taught in English does not automatically mean you
will be admitted to our courses.

6. REMAINING DECLARATION
I hereby request to be enrolled at Saxion University, academic year 2011/2012 and declare
that
 I hereby request the University Board to register me as a student for the academic year 2011-2012
 I have completed this form truthfully.
 I comply with the rules and regulations concerning my admission.
Date : (dd / mm / yyyy)
Signature :

If you are younger than eighteen years of age at the start of the programme, your parents or
legal representative should co-sign this form.
Name :
Date : (dd / mm / yyyy)
Signature :
Application form 2011 / 2012

7. IMPORTANT!
For a complete application please add the following docum ents to this application form:
• 1 copy of passport* • Curriculum Vitae
• 1 legalized copy of High School/Middle School • Proof of English language proficiency: (TOEFL,
diploma and grade list*/** IELTS); you have to submit original documents, or
• 1 legalized copy of all Higher Education legalised copies. Normal copies will not be
qualification and grade list (in English)*/** accepted)*!
• NESO Certificate***
In order to apply for an entry visa (MVV) Saxion University requires full payment of the package fee of the chosen course on the
University's Bank Account.
* Students must at all times be able to show original documents after arrival in the Netherlands.
** All diplomas and gradelists must be submitted in original language and official English translation.
When required documents are submitted to the Embassy in a student’s home country a birth certificate is also required, provided with an
apostile.
*** Only for Chinese students.

Please note that you’ll need a legalized birth certificate when coming to the Netherlands to register at the City Council.

In some countries, such as Pakistan, Dominican Republic and India, double legalisation is required. Please check with your nearest Royal
Netherlands (Dutch) Embassy or Consulate. This process could take up to 3 months.

Saxion University reserve the right to verify all documents submitted for application.

8. ADDRESS
You can send your application, together with the compulsory docum ents to:
Saxion University of Applied Sciences
International Office
PO Box 501
7400AM Deventer
The Netherlands