Application form Bachelor / Master programmes / English prep course Stenden University of applied sciences Personal data Please fill out in block letters. Family name male/female* single/married* First name(s) Nationality Date of birth (dd/mm/yyyy) Place and country of birth Address Postal code City Country Native speaker of (language) Telephone Fax country city number country city number Mobile number E-mail address country city number Passport number Issue date(dd/mm/yyyy) Expiry date(dd/mm/yyyy) My e-mail address can be used for commercial purposes, such as brochures and newsletters from Stenden Agent data For students who applied through a representative: Name company Contact person Agent address Permanent postal code City Country E-mail address Stenden is covered by the Governance Branch Code. The main points of this code are explained in the Annual Report and can be found at * Please encircle what applies to you. PAGE 1 OUT OF 5
Application data I want to apply for the following English programme (tick one box only): English Language Course/Pre Master Programme Long course: 36 weeks Short course: 18 weeks Pre Master programme: 18 weeks Location: And / or: Bachelor 4 year English programme: Business Administration International Business and Languages International Business and Management Studies International Hotel Management International Information Technology International Logistics Management International Tourism Management Leisure Management Media and Entertainment Management Education in Primary Schools Specialization International Emmen Emmen Emmen Meppel Or: Bachelor Short Track 1-3 year programme: International Hotel Management International Tourism Management And/or: Master programme: Master International Service Management, MISM (Fulltime 1 year) Master International Leisure & Tourism Studies, MILTS (Fulltime 1 year) I prefer to start the course in (Month & Year) September 20 February 20 (please check which programmes offer a February intake) How did you get to know about Stenden? Stenden website Publication, please state which: the embassy of in Education consultant or recruitment agent, please state name: A student or alumni of Stenden, please state name and relationship to you: Visit of fair, presentation (name, date of fair): Other: PAGE 2 OUT OF 5
Language abilities What proof do you have of English Language competency? Candidates, whose first language is not English, are required to take an English Language test, preferable IELTS or TOEFL. For information on TOEFL and IELTS testing, please visit www.ielts.org and www.toefl.org. IELTS: Score Date Score (dd/mm/yyyy) TOEFL: Score Date Score (dd/mm/yyyy) English as language of instruction Educational data Concerns only your studies at the secondary school, university or professional levels. Name of school/university Type of school Location Years attended Diploma (awarded/to be awarded + year of graduation) GPA score (Grade Point Average from your education) from to from to from to Personal Essay (motivation letter) Applicants must submit a digital version of a personal essay (300-400 words in English) in which they answer the following questions: Instructions for Bachelor applicants: What are the characteristics needed to be a good manager in your chosen field? Why are you interested in a career in management? (in your chosen field) Why should Stenden accept you as a student in your chosen management programme? Explain how you have researched your choice of study and prepared yourself for studying in the Netherlands. Please include the name and contact addresses of 2 persons who Stenden can contact for references and additional information on your application (those should not be relatives). Please include your Résumé / Curriculum Vitae Instructions for Master applicants: What do you expect from the study Programme At Stenden Masters we consider education to be a co-operation of knowledge by students alike. What could lectures and fellow students expect from you? What will be your contribution to the programme? (Think for example of knowledge, skills, experiences ) Please include the name and contact addresses of 2 persons who Stenden can contact for references and additional information on your application (those should not be relatives). PAGE 3 OUT OF 5
Extra application information Master programme Your application to the Master programme will be considered upon receipt of this form, including all the supplementary documents, plus a nonrefundable application fee of 125, (the fee is waived if you use the services of an agent who is an official representative of Stenden for the application procedure). Please arrange to pay this fee as soon as possible by instructing your bank to transfer the fee to our bank as per the following transfer details: Stenden IRC International Name of the bank: ABN Amro Bic code: ABNA NL2A Account No. 51.39.49.593 IBAN code: NL 72ABNA051.39.49.593 Payment should be made free of charge to the school. Please be sure that your name, passport number (if already available) and your birth date are included in the particulars of the payment. Signature I hereby certify that I have provided accurate information on this application. I understand that any misrepresentations or omissions of facts in my application may justify denial of admission, cancellation of admission or withdrawal from the programme. This is my honest statement. Date (dd/mm/yyyy) Place Signature PAGE 4 OUT OF 5
Checklist Documents A completed and signed application form Copy of passport (valid during at least one year upon arrival in the Netherlands) Copy of IELTS or original TOEFL results from attesting your knowledge of English Certified copy* of your diploma of your school/college/university education (in English, German, French or Dutch) Certified copy of grades-sheet (in English, German, French or Dutch) Curriculum Vitae / Résumé in English Your personal essay of 300-400 words in English Appendix Photocard for visa application (see attachment 1, needs to be returned by postal mail!) Antecedent Certificate for visa application (see attachment 2, needs to be returned by postal mail!) Authorisation form for visa application (see attachment 3) Copy of academic awards of honours, if available Proof of payment of the application-processing fee (only applicable to Master students ; not applicable if an agency that is officially recognized by Stenden handles your application); See explanation on page 4 of this application form. Copy of your valid Dutch residence permit (only applicable to Non-EU students already residing in the Netherlands) * A certified copy, which is authentically signed and stamped by an authorized representative of your school/university to proof the authenticity of the copy. Important: Please sign this application form and send it together with all the required documentation to Stenden. Application deadline is: Bachelor programme / English prep course: September intake: 31 st of May February intake: 1 st of November Master programme: September intake: 30 th of June Visa pick up Dutch embassy where I want to pick up Visa: City: Country: single/married* * Please encircle what applies to you. Please visit our English website ( EN Programmes Visa necessary?) For the required documentation needed for the MVV visa. Address For programs offered at location and Emmen Please send your documents to: Stenden Information & Registration Centre P.O. Box 1298 8900 CG The Netherlands Tel: +31 58 2441940 Fax: +31 58 2441555 E-mail: io@stenden.com Website: PAGE 5 OUT OF 5
Antecedents Certificate Please state the situation that applies to you below. This certificate only needs to be completed if the foreign national is 12 years of age or older. If this antecedents certificate has not been completed truthfully, this will have consequences for your right of residence. I certify that: I have never been sentenced to imprisonment or a custodial measure for committing a crime; I have never been sentenced to perform community service for committing a crime; I have never been imposed an unconditional fine for committing a crime; I have never accepted an out-of-court settlement for committing a crime; I have never been imposed a penalty order by a public prosecutor for committing a crime; I am currently not subject to prosecution for committing a crime; I have never been responsible for one of the following categories of acts as referred to in Article 1F of the 1951 Refugee Convention: a crime against peace, a war crime, a crime against humanity, a serious non-political crime (for example murder or terrorism), or acts contrary to the purposes and principles of the United Nations (for example terrorist acts); and I am aware of the fact that a sentence for committing a crime may result in a refusal or termination of the right of residence. I certify that: I have not submitted any incorrect data during earlier residence procedures; I did not reside in the Netherlands illegally in the past; I am not subject to any entry ban. I am unable to certify the above for the following reasons: Signing Place and date Signature
Authorisation form Personal data Please fill out in block letters. Family name First name(s) Date of birth (dd/mm/yyyy) Code of Conduct international student higher education (revised 4 December 2009) Art:4.7 Art:5.5 As part of the registration process, the higher education institution requests the admissible third-country national to agree in writing with the procedure used by the higher education institution to report the third-country national to the IND (whether or not with prior notice), in case the registration is terminated or after having established that the third-country national has not made satisfactory student progress as referred to in Articles 5.5 and 5.6 At the end of each academic year, the institution determines the annual student progress of the international student. Satisfactory student progress is considered: 50% (or more) of the proportional nominal study load for a full or partial academic year. Contrary to this, international students must successfully complete the preparatory year. In case of insufficient student progress, the institution will examine the cause, for instance by conducting a student's progress discussion with a student advisor. In case the international student does not study at all, does not study enough or cannot handle the level, the IND is notified of the lack of progress of the third-country national within one month after establishing the fact. In case of personal circumstances as referred to in Article 7.51 WHW as well as in Article 2.1 of the WHW Implementation Decree, which can be regarded as valid reasons for unsatisfactory student progress, binding agreements are made with the international student to catch up arrears so that the study can be completed in time. In such cases the IND will not be notified of the lack of progress of the third-country national. Only one exception for not notifying the IND about the lack of progress of the third-country national as a result of the same personal circumstances will be made per reference period per international student. The institution records any unsatisfactory progress and any personal circumstances as well as, in case of a third-country national, the fact that the IND was not notified(see the Appendix). Art:5.6 The IND will be informed as soon as the institution establishes the fact that a third-country national has terminated his/her registration at the institution. Signature Student PAGE 1 OUT OF 2 Please turn over
Transfer of personal details I, the undersigned, grant my expressed permission to Stenden University of applied sciences P.O. box 1298, 8900 CG To pass on my personal details to Ministry of the Interior and Kingdom Relations/ Immigration and Naturalisation Service (Ministerie van Binnenlandse zaken en Koninkrijksrelaties / Immigratie- en Naturalisatiedienst, (IND) If this authority requires this information concerning the Aliens Act 2000 (Vreemdelingenwet 2000) and/or to the municipality of (Gemeente or Emmen), if this authority requires this information concerning the Municipal Personal Records Database Act (Wet gemeentelijke basisadministratie persoonsgegevens). and/or Kamerbemiddeling (accommodation company) Insurance I, the undersigned am responsible to be fully insured (e.g. medically, liability and repatriation) during the complete study programme. Signature I hereby certify that I understand and justify withdrawal from the programme and cancellation of the visa/residence permit upon the above mentioned articles. And authorize Stenden to pass the necessary personal details to the previous mentioned parties. Date (dd/mm/yyyy) Place Signature Student PAGE 2 OUT OF 2