VLAAMSE INTERUNIVERSITAIRE RAAD (VL.I.R.) FLEMISH INTERUNIVERSITY COUNCIL Advanced University Education in Flanders, Belgium 1999-2000 + Application form for admission to an International Course Programme (ICP) in 1999-2000 or an International Training Programme (ITP) in 1999 + Application form for a VL.I.R. scholarship INTRODUCTION The detailed selection procedure and admission requirements are described in the publication entitled "Advanced University Education in Flanders-Belgium, 1999-2000" by the Vlaamse Interuniversitaire Raad - Flemish Interuniversity Council (VL.I.R.). This publication lists the various courses available in Flemish Universities and describes the selection procedure and admission requirements for the International Course Programmes (ICP) and the International Training Programmes (ITP), as well as the scholarships available for these programmes. This application form combines the application for a specific course or training programme with the application for a VL.I.R. scholarship. The candidate's eligibility for the course will be evaluated by a Scientific Admission Committee of the host university. The Scholarship Selection Board will use the same file to evaluate academically eligible candidates who have also applied for a VL.I.R. scholarship. __________________________________________________________________________ | Important note for residents of countries where participation in study | | and/or scholarship programmes abroad is subject to local regulations: | | It is your responsibility to make sure that your application does not | | conflict with your country's national regulations. | L________________________________________________________________________| INSTRUCTIONS 1. Complete this Application Form Complete this Application Form in full. All questions must be answered accurately. If a question is not relevant, answer "not applicable" or "n/a". Please complete the form in English. Answers must be legible, preferably typewritten or hand-written in block letters (black ink). Incomplete or illegible applications may be rejected. If necessary, use additional sheets of paper. + If you are applying for admission to an International Course Programme or International Training programme only, complete Part I only. + If you wish to apply for a VL.I.R. scholarship as well, you must also complete Part II of this form. 2. Documents to enclose + If you are applying for admission to an ICP or ITP only: 2.1 A notarized copy of your diplomas and transcripts of academic records (detailed list of results per academic year and per course). The grades obtained should also be mentioned. "Notarized" means that the documents must be authenticated by an official authority of your country, the educational institution that issued them or the Belgian diplomatic office. If you are still preparing for an examination at the time of application, you are requested to forward - as soon as the results are published - a certificate attesting the results to the same address as this application form. 2.2 A translation of the diplomas and transcripts in English, French or Dutch. These documents must be authenticated by an official authority of your country or by the Belgian diplomatic office. 2.3 A medical certificate that proves your ability to attend the programme, completed by a doctor accredited by the Belgian diplomatic office. 2.4 If possible document your proficiency in English, e.g. include a TOEFL certificate (a minimum score of 550 is required, or 213 on a computer-based TOEFL test); or include proof that part of your education was taken in English. This only applies to an ICP/ITP in which English is the medium of instruction. 2.5 A letter in which you explain your reasons for wishing to attend a course / training programme. 2.6 4 passport photos + If you are also applying for a VL.I.R. scholarship then add the following documents: 2.7 A notarized copy (effected by the local administration or by the Belgian diplomatic office) of your marriage certificate and the birth certificates of your children, if applicable. 2.8 A letter in which you set the reasons you feel justify your application for a scholarship. 2.9 If you know already where you will be employed upon completion of this course / training programme, then it would be useful to enclose a letter from your (future) employer detailing the job you will have and explaining why this course / training programme is important for that job. 3. Return the completed application file + If you are applying for admission to an ICP/ITP only, return this application form to the organizer of this specific ICP/ITP. These addresses are listed in the brochure entitled Advanced University Education in Flanders-Belgium, 1999-2000. + If you are also applying for a VL.I.R. scholarship, send the application form and requested documents to one of the following addresses: - The organizer of the ICP/ITP (addresses listed in the brochure entitled Advanced University Education in Flanders-Belgium, 1999-2000). - You may also send the application form to the VL.I.R., which will forward the file to the organizer of the ICP/ITP: Vlaamse Interuniversitaire Raad (VL.I.R.) ICP / ITP Registrations Egmontstraat 5 B-1000 Brussels Belgium Deadline for submission of your application: -If you are applying for admission to an ICP or ITP only, respect the deadline set by the organizer of the course. -If you are also applying for a VL.I.R. scholarship, your application file (i.e. application form and requested documents) MUST REACH US BEFORE 30 APRIL 1999. ------------------------------------------------------------------------------ PART I: Application for an International Course Programme (ICP) in 1999-2000 or an International Training Programme (ITP) in 1999 ------------------------------------------------------------------------------ ICP/ITP applied for (use the name of the course as indicated in the brochure) ICP /ITP: Period: 1. PERSONAL INFORMATION PLEASE NOTE: You must write your name in exactly the same way in this form and throughout the application procedure, otherwise you might experience difficulties when applying for a visa or plane ticket. Family name (surname): _______________________________________________________ Maiden and/or any other names that may have been used on documents: __________ First name (given name): _____________________________________________________ Sex (male/female): ______ Place of birth (country, town): ______ Date of birth (dd/mm/yy): _____/___________ / ______ Nationality at birth: ________________ Current nationality: ________________ Permanent address (as mentioned in your passport): Street, (box) number: ____________________________________________________ Postal code: ______________ City, State: _____________________________ Country: ______________________ Telephone number (country code - area code - phone number): ______________ Fax number (country code - area code - phone number): ____________________ E-mail: __________________________________ Current address (for correspondence regarding this application, especially in the period May - Sept. 1999): Name of contact person (if applicable): __________________________________ Street, (box) number: ____________________________________________________ Postal code: ______________ City, State: _____________________________ Country: ______________________ Telephone number (country code - area code - phone number): ______________ Fax number (country code - area code - phone number): ____________________ E-mail: __________________________________ Current address valid until: _________(changes in the address must be forwarded a.s.a.p.) Contact person in case of emergency: Family name: __________________________ First name: ______________________ Street, (box) number: ____________________________________________________ Postal code: ______________ City, State: _____________________________ Country: ______________________ Telephone number (country code - area code - phone number): ______________ Fax number (country code - area code - phone number): ____________________ E-mail: __________________________________ Marital status: married / single / divorced / widowed If married or having children: Surname First name Date of birth Place of birth Sex Family name Given name (dd/mm/yy) (M/F) Spouse Child Child Child Child Child 2. LANGUAGE SKILLS Mother tongue: Other languages: indicate with a number from 1 to 5 the degree of your knowledge: 1 = native speaker, 2 = excellent, 3 = very good, 4 = good, 5 = fair English French Dutch German Spanish ... ... speaking writing reading understanding If you are applying for a course/training programme in which English is the medium of instruction: Was part of your education in English: YES / NO + If so, which part: secondary / university / .. + How many years of English education did you receive? ___________ Do you have a TOEFL certificate: YES / NO + If so: TOEFL score: __________________ Date of this test: ________________ 3. EDUCATION Secondary studies (chronological) Period from Name & address Name of studies Qualifications Grade/ (dd/mm/yy) to of the obtained Results (dd/mm/yy) institution ____________________________________________________________________________ ____________________________________________________________________________ Post-secondary education or university studies (chronological) Period from Name & address Name of Language Qualifications Grade/ (dd/mm/yy) to of the studies used obtained Results (dd/mm/yy) institution ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Title and subject of thesis (also mention the results or grade obtained): Other formal studies, workshops, etc. (chronological) Period from Name & address Name of Language Qualifications Grade/ (dd/mm/yy) to of the studies used obtained Results (dd/mm/yy) institution ____________________________________________________________________________ ____________________________________________________________________________ Overview of non-formal additional training attended (chronological) Period from (dd/mm/yy) Name & address of Name of Subject to (dd/mm/yy) the institution supervisor ____________________________________________________________________________ ____________________________________________________________________________ 4. SCHOLARSHIP HISTORY If applicable, list the scholarships and grants you received previously (in your own country and/or abroad): Period Name and address of the Studies performed from (dd/mm/yy) organization which (institution, name of studies) to (dd/mm/yy) issued the scholarship 5. ACADEMIC PROFESSIONAL EXPERIENCE Research and teaching experience (chronological) (use a separate sheet if necessary). Please distinguish between research and teaching jobs. Period Name and address Name of subjects taught from (dd/mm/yy) of institution Description of research conducted to (dd/mm/yy) Name of supervisor Job title Fax and Telephone numbers List of publications 6. NON-ACADEMIC PROFESSIONAL EXPERIENCE (chronological) (use a separate sheet if necessary) Period from Name & address employer Position (job title) Sector (dd/mm/yy) Name of supervisor AND description of (eg education, to (dd/mm/yy) Fax & telephone numbers responsabilities industry, NGO) 7. EXTRACURRICULAR RECORD List extracurricular activities (school or community) in which you have been involved. Use a separate sheet if necessary, but do not exceed 1 page of text. 8. MOTIVATION Describe your reasons for wishing to attend this course / training programme. Use a separate sheet if necessary, but do not exceed 1 page of text. 9. FUTURE PLANS Describe your future plans. How will this course / training programme be useful to the further development of your career? If you are to be employed after completing this course / training programme, how will this education be useful in your future profession? Also, give the name, address, phone and fax numbers of your future employer. If applicable, add a declaration from your future employer explaining the importance of this course / training programme. Use a separate sheet if necessary, but do not exceed 1 page of text. 10. FINANCIAL RESOURCES If you are not applying for a VL.I.R. scholarship, you are required to provide evidence of sufficient funds to cover academic and living expenses. You must certify that you will have a minimum income of at least BEF 25,000 (620 euros) per month for the entire duration of the intended study period in Belgium. If you intend to bring your family to Belgium, you must provide evidence of a higher income. Are you applying for a scholarship to attend this course / training programme, other than the VL.I.R. scholarship? YES / NO If so:-name of scholarship agency (institution, ...): ________________________ -address and contact person at the scholarship agency: _________________ - amount: ___________________ - period covered: _______________________ - Have you received confirmation that you will be granted this scholarship? YES /NO - If so, attach a copy of this confirmation letter. - If not, when do you expect to receive an answer to your application? ___________ What other sources of funds could you dispose of during your study period? Source Amount (in USD) / month ------ ----------------------- Self support USD Family or individual sponsors USD Government, company or USD other scholarships/grants ... USD ... USD Do you plan to bring your spouse and/or children to Belgium? YES /NO If so, when would they travel to Belgium? _________________________ 11. ADDITIONAL INFORMATION Provide any useful additional information. Use a separate sheet if necessary, but do not exceed 1 page of text. 12. REFERENCES Give the name of two referees. State their function and give their telephone and fax numbers, as well as their e-mail addresses, if applicable. If possible, one of the references should be from the institution at which you are presently employed. Enclose two letters of recommendation, if available. These letters of recommendation should detail the following: how long the referee has known you; how well he/she thinks you are capable of adapting to different working and living conditions; your main strengths and weaknesses in a professional/ scientific context. The letters of recommendation must be enclosed in a sealed envelope, signed across the back flap. Name of referee Contact address Contact address, phone & fax, e-mail address Your relationship to this person 13. ADDITIONAL QUESTIONS 1. Where and how did you first hear about this programme? 2. Have you already applied for other programmes in Belgium? YES / NO If so, which ones and what was the outcome? Programme Outcome ------------------------------------------------------------------------------ PART II: Application for a VL.I.R. scholarship ------------------------------------------------------------------------------ 1. MOTIVATION Enclose a separate letter detailing your reasons for applying for a VL.I.R. scholarship. 2. WORK PLANS If you are applying for an International Training Programme: what are your study and work plans, both during and after your training course? Use a separate sheet if necessary, but do not exceed 1 page of text. 3. USE OF KNOWLEDGE upon return to your home country How will you use the knowledge you have acquired upon returning to your home country? How will it fit in with your future profession? Use a separate sheet if necessary, but do not exceed 1 page of text. 4. TRANSFER OF KNOWLEDGE upon returning to your home country How will you transfer the acquired knowledge upon returning to your home country? Who will benefit from your knowledge? Use a separate sheet if necessary, but do not exceed 1 page of text. 5. FINANCIAL RESOURCES Have you applied for other scholarships to attend this course / training programme earlier? YES / NO If so, what was the result of your application? ------------------------------------------------------------------------------ PART III: Declaration by the applicant (to be completed by all applicants) ------------------------------------------------------------------------------ I hereby declare on my word of honour that this information is correct and complete and that I shall immediately inform the VL.I.R. of any changes in my situation, including my family situation. I shall immediately inform the VL.I.R. of any additional income from another scholarship, allowance or employment. I hereby agree that any false statement I make in this application shall result in the immediate cancellation of my scholarship. Name: _______________________________________________ Signature: Date: ____________________________