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Application formdeadline for receipt: 31 May

University of Antwerp

IN ORDER TO SECURE YOUR SEAT, EARLY APPLICATION IS ESSENTIAL.ON-LINE APPLICATIONS (www.itmma.ua.ac.be) WILL BE ASSESSED IMMEDIATELY.

All questions in this application form must be answered clearly and conscientiously. If a question is not relevant to you, just fill in no, none or not applicable.The answers have to be legible, preferably type-written or handwritten in capital letters. All information asked for (diplomas, certificates, etc.) has to beenclosed. Incomplete or illegible application forms may affect the enrolment.Please complete all sections of this form and return to:ITMMA University of Antwerp ITMMA House Keizerstraat 64 B-2000 Antwerp BelgiumTel.: ++32 (0)3 265 51 51 ++32 (0)3 265 51 52 Fax: ++32 (0)3 265 51 50 E-mail: [email protected]

I. PROGRAMME SELECTION

I would like to apply for (please tick boxes):

q M.Sc. IN TRANSPORT AND MARITIME MANAGEMENT (MTMM): q full-time q part-time

q M.Sc. IN TRANSPORT AND MARITIME ECONOMICS (MTME) q full-time q part-time

q Pg. Dip. IN TRANSPORT AND LOGISTICS MANAGEMENT (Pg.Dip.TLM) q full-time q part-time

Recentphotograph

Please complete the form electronically using the specified form fields

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II. PERSONAL DETAILS

Surname/Family name: .................................................................................................................................................................

First names: ............................................................................................................................................q male q female

Nationality: ....................................................................................................................................................................................

Date of birth (day, month, year): ............ / ............. / ........... Place and country of birth: ...........................................................

Marital status: ...............................................................................................................................................................................

III. CONTACT DETAILS

1. Address for correspondence: ......................................................................................................................................................

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Daytime telephone: ................................................................ Evening telephone: ..................................................................... Country code Area code Number Country code Area code Number

Fax: .......................................................................................... E-mail: ........................................................................................ Country code Area code Number

2. Permanent address (if different from Address 1.): .....................................................................................................................

........................................................................................................................................................................................................

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Daytime telephone: ................................................................ Evening telephone: ..................................................................... Country code Area code Number Country code Area code Number

Fax: .......................................................................................... E-mail: ........................................................................................ Country code Area code Number

Note: If you are to change addresses, please state when we should begin to write you at Address 2: ......................................

........................................................................................................................................................................................................

Correspondence regarding acceptance has to be mailed to: (Address 1., Address 2., Both): .......................................................

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IV. LINGUISTIC ABILITIES

Fill in: 1 = native speaker 2 = excellent 3 = good 4 = moderate 5 = minimal

speaking writing reading understanding

English

If English is not your first language, please give details of English language courses attended and qualifications attained. Please

include some evidence of your English language ability.

Examining board/authority Exam title Result Date

2 1 1 1

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V. EDUCATION HISTORY

A. HIGH SCHOOL

B. UNIVERSITY OR COLLEGE (OF ADVANCED/HIGHER EDUCATION), including current studies. If your qualification is not

from a Belgian university, please enter the actual title that is mentioned on the award or on the official translation (not its

equivalent to the Belgian classification) and enclose a complete transcript of your academic records.

C. POSTGRADUATE ACADEMIC STUDIES

D. ADDITIONAL TRAINING(e.g. short-term courses, seminars)

........................................................................................................................................................................................................

........................................................................................................................................................................................................

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................................................................................................................................................... (If necessary continue on a separate sheet)

Dates attendedIndicate whether full-time

or part-time

frommonth/year

tomonth/year

Name and address of the school Qualification and grades achieved


(If necessary continue on a separate sheet)


(If necessary continue on a separate sheet)

Dates attended

Indicate whether full-timeor part-time

frommonth/year

tomonth/year

Dates attendedIndicate whether full-time

or part-time

from

month/year

to

month/year

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VI. EMPLOYMENT HISTORY

(This section is not applicable for the MTME programme) List all positions you have held, beginning with your current or last position

Name of the organisation: .............................................................................................................................................................

Full address: ..................................................................................................................................................................................

Contact person: .................................................................. E-mail: .............................................................................................

Telephone: ............................................................................... Fax: ............................................................................................. Country code Area code Number Country code Area code Number

Title of your position: ....................................................................................................................q full-time q part-time

Duration(number of years and months): ............................... From (day/month/year): .........................to (day/month/year): ...........................

Brief description of your duties: ....................................................................................................................................................

........................................................................................................................................................................................................

........................................................................................................................................................................................................

........................................................................................................................................................................................................

...................................................................................................................................................(If necessary continue on a separate sheet)


Full address: ..................................................................................................................................................................................






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Full address: ..................................................................................................................................................................................






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Your application must include the following documents:

1. One completed application form. The application form can also be downloaded from the ITMMA website

(www.itmma.ua.ac.be).

2. Legalized copy of your diploma(s) - high school diploma as well as university/college diploma(s) - and certificate(s) or other

official statements. If this diploma or certificate has been issued in another language than Dutch, French, English or

German, it must be accompanied by a translation in one of these four languages. This translation must be delivered by

sworn translator and, if applicable, legalized.

3. A complete list of all courses followed and results obtained, in other words, an academic transcript.

4. An official certificate which proves your knowledge of English (not applicable for English native speakers).

For students whose first language is not English, the following qualifications will meet the English language requirement

for entry to the MTMM or MTME programme:

a first degree from a European university or college;

or a first degree from an overseas institution recognised by the Institute as providing adequate

evidence of proficiency in the English language;

or a TOEFL (Test of English as a Foreign Language, www.toefl.org). A score of 550 minimum for the

paper-based test (PBT) is required or 213 for the computer-based test (CBT);

or the British Council IELTS (International English Language Testing Service, www.ielts.org)

with a minimum score of 6.5);

or satisfactory standard in the verbal section of the Princeton Test (GMAT, Graduate Management

Admission Test, www.gmat.org). Submitting a GMAT score will strongly support the application;

or equivalent tests from accredited language testing organisations; or other evidence of proficiency in the English language which satisfies the Executive Board;

5. For the MTMM programme: two references from individuals. Ideally, one reference should be from a current employer

and the other from a referee who taught you at university level.

For the MTME programme: two references from individuals (preferably from academic staff) who have direct

knowledge of your suitability for postgraduate study.

For the Pg. Dip. programme: two references, preferably from your current employer. These documents should

preferably be sent directly by the referees to the ITMMA registration office.

6. A recent photograph.

7. A complete curriculum vitae.

8. A list (not a copy!) of your publications (if any).

All documents should be accompanied by an official English translation. Documents in Dutch, French and German do not

need to be translated.

All information asked for in the application form has to be provided in a clear way. In case a question is irrelevant to you, just

fill in no, none or not applicable. Incomplete or illegible application forms may affect the enrolment.

The application form should reach the ITMMA registration office before 31 May preceding the start of the next

academic year.Only in view of special circumstances, late applications may be considered.

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VII. REFERENCESPlease arrange for two referees to provide a letter of reference, preferably type-written on letterhead paper. For the MTMM programme: two references fromindividuals. Ideally, one reference should be from a current employer and the other from a referee who taught you at university level. For the MTME programme:two references from individuals (preferably from academic staff) who have direct knowledge of your suitability for post-graduate study. For the Pg.Dip.programme: two references, preferably from your current employer. State below the names, addresses (and telephone number, fax number and e-mail if known)of the referees. If a referee is your current employer and you do not wish us, at this stage, to contact him/her, please do not write the name and addressbut enter current employer, do not contact yet.

Reference 1:

Full name: ......................................................................................................................................................................................

Address: .........................................................................................................................................................................................

E-mail: ............................................................................................................................................................................................


Reference 2:

Full name: ......................................................................................................................................................................................

Address: .........................................................................................................................................................................................

E-mail: ............................................................................................................................................................................................


VIII. FURTHER INFORMATION

How did you find out about ITMMA? (please tick box)

q From a current or former student q From a prospectus ...............................................................................

q From the Internet q From an advert (please state newspaper/journal): .............................

q From a Careers Office q Other (please specify): .........................................................................

X. FINANCIAL DETAILS

How will your programme fee, accommodation and living expenses be financed ? Please give full details of any sponsoring

organisation(s) including letters of sponsorship. Note that ITMMA does not award scholarships.

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DECLARATIONI declare that the information on this form is complete and correct to the best of my knowledge and agree, if registering

as a student, to abide by all of the Universitys regulations. I understand that inaccurate, incomplete or illegible information

may affect my enrolment.

Signed ........................................................................................... Date ..............................................................................................

NOTE: Only one original application form (accompanied by the documents mentioned at the back of this application form) has to reach the ITMMAregistration office before 31 May. If necessary, send it by fax first.

copy 2009