ECTS application form TU/e Electrical Engineering - Technische ...

STUDENT APPLICATION FORM EXCHANGE STUDENTS
Please complete this form using your PDF-reader before printing. Only if editing in your
PDF-reader is impossible, print first and fill in by hand using black capital letters.
STUDENT’S PERSONAL DATA
(to be completed by the student applying, data should be conform information in passport)
Family name (for married woman maiden
name):
Date of birth: / /20
Sex: Male Female
Place of birth:
Country of birth:
First name(s):
Marital status: unmarried married
Nationality:
Current address:
Permanent address (if different):
Tel:
Fax:
E-mail:
Tel:
Fax:
E-mail:
SENDING INSTITUTION (HOME UNIVERSITY)
Name and full address:
Departmental coordinator
Name:
Telephone:
Fax:
E-mail:
Institutional coordinator
Name:
Telephone:
Fax:
E-mail:
PREVIOUS AND CURRENT STUDY
Diploma/degree for which you are currently studying:
Current field of study:
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Number of higher education study years prior to departure abroad:
Have you already been studying abroad? Yes No
If Yes, when? At which institution?
The attached Transcript of records includes full details of previous and current higher
education study. Details not known at the time of application will be provided at a later
stage.
RECEIVING INSTITUTION
PREFERRED FIELD OF STUDY AT TUE:
Period of study
Semester A:
Semester B:
N° of expected
ECTS credits
Preferred type of study during stay at TU/e:
Courses
Research project, please specify in which research area:
Final project/thesis project, please specify in which research area:
Internship, please specify in which research area:
Briefly state the reasons why you wish to study abroad?
NATURE OF VISIT AND GRANT
What is the nature of your visit?
Erasmus study (courses, traineeship, at the university, on the basis of a bilateral agreement)
Erasmus student placements (in a company)
Erasmus Mundus External Cooperation Window
Within the scheme of another (non-Erasmus) bilateral agreement between TU/e and your
institution
Free mover
Other, please specify:

LANGUAGE COMPETENCE
Mother tongue:
Language of instruction at home institution (if different):
I have sufficient knowledge to follow lectures in: Yes No
English
(Dutch
EER-Students:
Non EER Students:
WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
Please enclose:
- copy of passport
- transcript of records of previous and current higher education
- learning agreement with proposed study program (if already known)
- proof of sufficient mastery of the English language
Please return this form to:

DECLARATION AND SIGNATURES
SENDING INSTITUTION
Coordinator’s Name:
Coordinator’s signature:
Date:
Stamp institution:
RECEIVING INSTITUTION: TU/e
(to be completed by TU/e Department of )
We hereby acknowledge receipt of the application, the candidate’s transcript of records and the
learning agreement.
The above-mentioned student is
Accepted at our institution
Not accepted at our institution
Departmental coordinator’s signature:
Date:
Supervisor TU/e: _________________________________________________________
Bachelor’s/Master’s program: _______________________________________________
Period of study at TU/e: ____________________________________________________

Annex I
Application form for Services (compulsory)
Family name (for married woman maiden name):
First name(s):
Date of birth:
Email:
/ /
Place of birth:
Country of birth:
Nationality:
Sex: male female
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Wishes to apply for:
ACCOMMODATION (please answer the following questions)
For more information on housing for exchange students please visit www.tue.nl/housing
Accommodation period for: Semester 1
accommodation myself.
Please note that the above mentioned period is the period of the rental agreement of the accommodation. This period may differ
from the academic semester dates.
The costs for accommodation are approx. 2000 to 2500 euro for one semester.
Special remarks:
Semester 2
I do not want to make use of the accommodation service. I will arrange
VISA 1 (please answer the following questions):
Do you have a Dutch residence permit: Yes No
(If you choose “no” and you need a VISA the TU/e will apply for it)
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Insurance (please answer the following questions)
Do you have health insurance? 2 Yes No
Do you have liability insurance? Yes No
If you do not have insurance you need to contact the International Relations Office on arrival. We can
arrange insurance for you with AON (www.students-insurance.eu)
Undersigned by:
Student
Coordinator
1 If you come to the Netherlands as an exchange student for more than 3 months you might need an MVV (visa) to enter the Netherlands.
Students with the nationality of one of the following countries do not need to apply for a visa to enter the Netherlands: One of the countries
of the European Union, Iceland, Norway, Liechtenstein, Switzerland, Monaco, Australia, New Zealand, Canada, the United States of
America and Japan.
2 The Netherlands has signed treaties regarding health insurance with the following countries: all of the EU member states, Norway, Iceland,
Liechtenstein, Turkey, Morocco, most of the countries of former Yugoslavia, Tunisia, Cape Verde Islands and Australia. If you are insured
under the national health insurance scheme of one of these countries, your insurance company can provide you with an international
declaration form called E-111 or E-128. Make sure to bring this form with you to the Netherlands.

Annex II
Statement of home institution regarding mastery of the English language
Family name (for married woman maiden name):
First name(s):
Date of birth: / / Place of birth:
Email:
Country of birth:
Nationality:
Sex: male female
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Undersigned Coordinator confirms that the mentioned student has a sufficient knowledge of the
English language comparable with:
an original Academic IELTS score of at least 6.0 on average
or TOEFL scores of at least 80 (Internet-based), 213 (computer-based) or 550 (paper-based).
Name coordinator:
Date:
Signature coordinator
Stamp institution
Non EER students need to enclose one of the following language test with the application forms:
- An original Academic IETLS test with a score of at least 6.5 on average;
- An original TOEFL test with a score of at least 90 (internet based).