Summer Course

Current Personal data
Professional background
Declaration and privacy
Complete

Personal data

Maastricht University student number (if applicable)

Gender

Last name (as in passport)

Last name prefix:

First names (as in passport)

Given name

Initials

Place of birth

Date of birth

Country of birth

Nationality

Address

City/Town

State/Province

ZIP/Postal Code

Country

Telephone number

I will pay

By myself

By my employer (please mention your institute/company)

Other (please mention if this is a private person or company)

Company

Planned date of arrival

Professional background

Occupation

Department

Faculty/School

University/Institute

Please briefly describe your background (i.e. education and/or experience)

Declaration and privacy

I confirm that, to the best of my knowledge, the information provided on this form is correct.

SHE (School of Health Professions Education), a school of Maastricht University, located in Maastricht, Universiteitssingel 60, the Netherlands, is responsible for the processing of the personal information as displaced in this privacy statement.

Here you can find more information about our privacy policy.

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