7/27/2019 Entrance Acceptance Form2

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INTERNATIONAL INSTITUTEFORAEROSPACESURVEYANDEARTHSCENCESENTRANCEACCEPTANCEFORMPlease type or pri nt i n bl ockcapi tal sSurname or f a m l y name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mr / Mr s/ other . . . . . . . .

( pl ease stateyour t i t l e )For ename( s)

The name whi ch you g i v e on t h i s formw i l l be r e g i s t e r e d by I TC andthe appropri ate Dut ch publ i c s e r vi c e depart ment s, andw i l l a l s o go i n t o I Tcomputer i zed al umni address s y s t e m i t i s t h e r e f o r e i mport ant t h a t you compl ete your names i n the c o r r e c t o r d e r , e g . : SMTHMRJOHNPPl easebe aware t h a t you cannot change your name at a l a t e r dote .

Passport numberI ssued byPl ace o f i s s ueDate of i s s u e ( d ay , mont h, year)Val i d u n t i l ( d a y , mont h, year)

I amaware t h a t myp a s s p o r t mus t not c ont a i n e xc l u s i o n c l a us e s f o r any country i n West ern Europe, northern andc e n t r a l A f r i c a , or southernSuch e x c l u s i o n s can prevent me f romp a r t i c i p a t i n g i n compul sor y f i el dwork o r study t r i p s t h a t are i n t e g r a l p a r t of mycourse Wthout p a r t i c i pthese I underst and t h a t no di pl oma can be ` conf erred by I TC

Si gnature

Date

P.OBox67500AA EnschedeTheNetherl ands

b) I cannot havemy w i f e or myf a m l y accompanyme t h e r e ;

Thi s formshoul d be returned t o : I TCStudent Regi s t ra t i on Of f i ce

ETC

I underst and' t h a t : a) my r e gi s t r a t i on f o r t h i s I TCc o u r s e i ncl uded o b l i g a t o r y r e s e r v a t i o n of a room i n theDSH h o t e l or i t s annex

c) myd e f i n i t i v e admssi on t o t h e course maydepend on a p o s s i b l e medi cal check w i t h i n aweek a f t e r a r r i v a l

Address

Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I i nt end t o r e g i s t e r f or t he I TCcourse coded . . . . . . . . . . . . . .whi ch begi ns on . . . . . . . . . . . . . . . . . . . . l a s t i n g . . . . . . . . . . . . .mI have recei ved a f el l owshi p f r om . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Address of sponsor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I w i l l ar r i v e at Schi phol air port on ( date) . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . h o u r s , f l i g h t number . . . . . . . . .I w i l l not f l y but w i l l a r r i v e i n Enschede on ( d a t e )