Personal Data
Name ………………..
Date of Birth ………………..
Address ………………..
………………..
Country of Residence ………………..
Telephone number ………………..
Email address ………………..
Student number ………………..
Which country do you consider your home country? ………………..
Nationality (list all) ………………..
………………..
………………..
Country of Birth ………………..
Nationality Father ………………..
Nationality Mother ………………..
Do you have other relatives (grandparents, stepparents) that have a different nationality than you or one of your parents? ………………..
Language you speak at home ………………..
Countries you officially lived in ………………..
………………..
………………..
………………..
………………..
Language Knowledge: Please rate your abilities for each language dimension on the following scale: Native/Excellent/Good/Average/Poor
Speaking Writing Reading Years studied Hrs p/w
English ……………….. ……………….. ……………….. ……………….. ..
Dutch ……………….. ……………….. ……………….. ……………….. ..
German ……………….. ……………….. ……………….. ……………….. ..
French ……………….. ……………….. ……………….. ……………….. ..
Spanish ……………….. ……………….. ……………….. …………………. ..
Other ……………….. ……………….. ……………….. ……………….. ..
Language courses outside of home country
Language Where (Institute/Location/Country) Time period Hrs p/w
……………….. ……………….. ……………….. …..
……………….. ……………….. ……………….. …..
Language courses in home country
Language Where (Institute/Location/Country) Time period Hrs p/w
……………….. ……………….. ……………….. ……
……………….. ……………….. ……………….. ……
Language certificates/diplomas (type Cambridge Exam, DILF, …)
Language Where (Institute/Location/Country) Time period Hrs p/w
……………….. ……………….. ……………….. ......
……………….. ……………….. ……………….. ……
International education during secondary school
Which secondary school did you attend, tick the box.
Time period
□ Usual secondary school ………………..
□ Official bi-lingual secondary school ………………..
□ International school with International Baccalaureate ………………..
Country (or countries) where you followed at least one year secondary school :
………………………………………………..
International exchanges
Please list each international student exchange project (e.g., year abroad, term abroad, etc.) you participated in:
Description Where (Institute/Location/Country) Time Period
……………….. ……………….. ………………..
……………….. ……………….. ………………..
International school trips
Please list each international school trip you participated in
Description Where (Location/Country) Time period
……………….. ……………….. ………………..
……………….. ……………….. ………………..
International school projects
Please list each international school project (e.g., Euroscola, Model United Nations etc.) you participated in
Description Where (Location/Country) Time Period
……………….. ……………….. ………………..
……………….. ……………….. ………………..
Experience outside secondary school Extracurricular studies
Please list each study you followed outside/after secondary school (e.g., non-language oriented summer schools , current academic study, etc.)
Description Where (Institute/Location/Country) Time Period Hrs p/w
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
Internships/apprenticeships/work experience
Please list all internships / apprenticeships /work experience you participated in
Description Where (Institute/Location/Country) Time Period Hrs p/w
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
Volunteer work
Please list all volunteer work experience
Description Where (Institute/Location/Country) Time Period Hrs p/w
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
Other activities (e.g., class / school representative, cultural performances, starting an own business, etc.)
Please list all other activities you have been involved with in some detail.
Description Where (Institute/Location/Country) Time Period Hrs p/w
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
……………….. ……………….. ……………….. ..
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