APPLICATION FORM

Application Form for VIA Summer School 2013
This is the Application Form for VIA Summer School 2013
In order to apply for any curse, please follow the instructions below:
1. FILL IN the Application Form electronically
(read the questions carefully and provide all required information at the darker background).
2. PRINT * filled Application, in order to add your personal signature and stamp from your home
institution, if necessary.
* You do not need to print and scan this page; we require only a page with your input from pages 3-5
Black & White prints are acceptable
3. SCAN your Application in the following way:
 file name must be YOUR FULL NAME
 file format must be .PDF
4. SEND your Application electronically to: [email protected] where:
 the message title must be “Application – your 1st name(s), surname”
(use your original letters)

eventually you can send your Application by post (address you will find in the end of this
document). Please inform us about this before by sending an email!
5. Within a week upon receipt of your Application, you should receive an official email of
CONFIRMATION with further instructions about procedure and payment.
Please fill in now all necessary information correctly, categorized in the following groups:
1
Application Form for VIA Summer School 2013
INFORMATION ABOUT COURSES:
1. I would like to participate in the following course(s):
COURSE INITIALS – COURSE FULL NAME
TERM 1
1 July – 12 July
TERM 2 15 July – 26 July
TERM 3 29 July – 9 August
Be aware, that some courses last for 4 weeks. Consequently those courses are running during 2 terms.
2. Please select your 2nd priority courses in case the course from your first choice will not run this
summer:
COURSE INITIALS – COURSE FULL NAME
TERM 1
1 July – 12 July
TERM 2 15 July – 26 July
TERM 3 29 July – 9 August
ACADEMIC INFORMATION
1. Please select your type of participation (only one option is possible):
A
I am currently a FULL DEGREE student at VIA UC, Horsens
B
I am studying at another Danish school of higher education
DENMARK
C
EU / EEC countries
D
E
I am EU/EEC exchange student from
a VIA partner institution
I am EU/EEC exchange student from
a non VIA partner institution (Free mover)
I already graduated from a school of higher education
(Open University for EU/EEC)
F
I am an international exchange student (non-EU/EEC)
G
I already graduated from a school of higher education
(Open University for non EU/EEC)
Non EU / EEC countries
Follow the capital letter from the description of your type.
2
Application Form for VIA Summer School 2013
CREDIT TRANSFER CONFIRMATION
According to your participation type, please fill the appropriate field. In case you want to get a preapproval of credit transfer (ECTS) upon completion of VIA Summer School courses, you should contact the
head of department at your home university or international office.
A
I am currently a FULL DEGREE student at VIA University College, Horsens
Department:
Student Number:
CPR Number:
Yes, I will be awarded credit transfer (ECTS) upon completion of VIA Summer
School courses.
Date
Head of department signature
No, I will not be awarded credit transfer (ECTS) upon completion of VIA
Summer School courses, but I still want to participate.
Please note,
if you cannot document pre-approval of credit transfer, you must pay participation fee in order to
apply for each course from VIA Summer School programme. Check pricelist on last page.
B
I am studying at another Danish school of higher education
University Full Name:
Department:
Year of Enrolment:
CPR Number
City:
Semester Passed:
Yes, I will be awarded credit transfer (ECTS) upon completion of VIA Summer
School courses.
Date
Head of department signature
No, I will not be awarded credit transfer (ECTS) upon completion of VIA
Summer School courses, but I still want to participate.
Please note
If you cannot document pre-approval of credit transfer, you must pay participation fee in order to
apply for each course from VIA Summer School programme. Check pricelist on last page.
3
Application Form for VIA Summer School 2013
C
I am EU/EEC exchange student from a VIA partner institution
You can check VIA partner institutions at: www.viauc.com/Documents/VIA-University-College-Cooperative-Partners.pdf
University Full Name:
Department:
Year of Enrollment:
CPR Number
City:
Semester Passed:
Yes, I will be awarded credit transfer (ECTS) upon completion of VIA Summer
School courses.
Official stamp of School / Department
Name + Signature
Head of Department / International Office
No, I will not be awarded credit transfer (ECTS) upon completion of VIA
Summer School courses, but I still want to participate.
Please note
If you cannot document pre-approval of credit transfer, you must pay participation fee in order to
apply for each course from VIA Summer School programme. Check pricelist on last page.
D
I am EU/EEC exchange student from a non VIA partner institution (Free mover)
University Full Name:
Department:
Year of Enrolment:
City:
Semester Passed:
Please note,
If you have doubts whether your institution is a VIA partner ask your head of department
/international office. You can check the list of VIA UC partners by following this link:
www.viauc.com/Documents/VIA-University-College-Cooperative-Partners.pdf
Be aware that Free Movers must pay participation fee in order to apply for each course from VIA
Summer School programme. Check pricelist on last page.
4
Application Form for VIA Summer School 2013
E
I already graduated from a school of higher education (Open University for EU/EEC)
University Full Name:
Degree / Diploma:
Year of Graduation:
City:
Please note,
Free Movers from EU/EEC countries must pay participation fee in order to apply for each course
from VIA Summer School programme. Check pricelist on last page.
F
I am an international exchange student (non-EU/EEC)
University Full Name:
Department:
Year of Enrollment:
City:
Semester Passed:
Be aware
International exchange students from non-EU/EEC countries are obliged to pay participation fee and
tuition fee for each course from VIA Summer School programme. Check pricelist on last page.
G
I already graduated from a school of higher education (Open University for non EU/EEC)
University Full Name:
Degree / Diploma:
Year of Graduation:
City:
Be aware
International exchange students from non-EU/EEC countries are obliged to pay participation fee and
tuition fee for each course from VIA Summer School programme. Check pricelist on last page.
5
Application Form for VIA Summer School 2013
PERSONAL INFORMATION
First name(s):
Date of birth (dd.mm.yyyy):
Citizenship:
Address (street):
Zipcode :
Phone No. with country code:
Email address:
Surname:
Gender:
Passport/ ID No. (not for DK students):
City:
Country:
ACCOMMODATION
Before you answer this question, please check our accommodation options described at the link below.
You can also easily change your answer about chosen accommodation type, by sending us an email before
APPLICATION DEADLINE. http://www.viauc.com/horsens/programmes/summerschools/accommodation/Pages/accommodation.aspx
1. Would you like VIA Summer School to provide you accommodation during your studies?
No, I will find accommodation on my own
Yes, I would like to stay at the dormitory room provided by VIA Summer School
Yes, I would like to stay at the classroom facility provided by VIA Summer School
I would prefer to live together with (name and surname of another participant of VSS):
PAYMENT
Courses and accommodation are paid online through VIAPAY no later than 14 days after receipt of the
official application confirmation. You will receive payment instructions with your letter of confirmation.
CANCELLATION
Be aware that registration is binding. However, you may cancel your registration by contacting
[email protected] If you cancel two full weeks prior to VIA Summer School you will get a
refund; if you cancel later than two weeks prior to VIA Summer School the payment is forfeit. We reserve
the right to cancel courses if too few have applied for the relevant course or in case of force majeure. In
case of cancelled courses, we will offer you the choice to participate in other courses or to have a full
refund.
ADDITIONAL INFORMATION
1. How did you find out about VIA Summer School?
(e.g.: poster, google, friend, etc)
2. Did anybody personally recommend you to participate in VIA Summer School?
Please type full name of this person:
2. Level of your English skills (basic / intermediate / advanced)
6
Application Form for VIA Summer School 2013
PRICE LIST
Participation fee
100
EUR / course
Tuition fee
600
EUR / course
Room in dormitory
100
EUR / week
Classroom facility
30
EUR / week
Deposit for accommodation
100
EUR (refundable)
Check our scholarship and other financial offers at:
http://www.viauc.com/horsens/programmes/summerschools/via/application/Pages/scholarships.aspx
CONTACT INFORMATION
If you have any problems with the application, do not hesitate to contact the VIA Summer School team.
Email:
[email protected]
Adress:
Office:
VIA Summer School
VIA University College
Chr. M. Oestergaards Vej 4
DK-8700 Horsens
VBI 4.10B
Facebook:
www.facebook.com/VIASummerSchool
PERSONAL SIGNATURE
I hereby declare that the information given is correct and I want to participate in VIA Summer School with
the selected courses and accommodation.
Date
Student’s Signature
7