Application Form VUB Summer School 2015.docVIP

Application Form VUB Summer School 2015 Experience the EU Capital – Brussels, 14-30 July 2015 布鲁塞尔自由大学2015年夏令营申请表 Filled by applicant 由申请人填写 Family name （姓） Photo First name（名） Gender (M/F) Full address Postal code City Country E-mail address Home phone number Mobile phone number Nationality Passport No° Date of Birth (dd/mm/yy) Highest diploma/degree Home university Major Current year of study Contact person in case of emergency, name phone number （紧急情况联系人姓名及电话） Date (dd/mm/yy) : Signature of applicant （申请人签字）: Filled by home university 由中国校方联系人