MA Design Application Form

Please complete carefully in English, block capitals and black ink and return to:

Utrecht School of the Arts

Faculty of Visual Arts and Design

MA Design

application 2009/2010

Ina Boudier-Bakkerlaan 50

3582 VA Utrecht

The Netherlands

Application for (please indicate one master course) :

Master of Arts in Design pathway Editorial Design

Master of Arts in Design pathway Fashion Design

Master of Arts in Design pathway Interior Design

Master of Arts in Design pathway Public Space Design

Applicants for the programme should complete the additional MA project proposal form enclosed with this form.

1. Personal details

Surname or family name ______

Other names in full ______

Title (Mr/Mrs/Miss/Ms etc) ______

MaleDate of birth

Female(dd|mm|yy)

Home address (please write down your entire address including the postal code, city and country) ______

______

______

______

______

______

Telephone ______Email ______

Passport valid from ______to ______

Nationality ______Country of birth ______

Country of permanent residence______

It is essential that you inform your institution immediately if you change your address

Emergency contact name: ______

Tel: number ______

Addres: ______

Health Insurance: (You are required to have insurance for all modules).

Details: ______

Special Needs

Please give details of any disabilities/medical conditions which might require special arrangements, facilities or medical attention:

______

______

2. Higher Education

Non European/EU applicants should send certified copies of qualification certificates, certified transcripts etc. with this form.

a. Degree/qualifications already obtained

Name of University, Polytechnic or College ______

Degree/qualification title ______

Subject(s) studied ______

______

______

Entry date ______Leaving date ______

Class/Grade ______

Language of instruction ______

b. Degree/qualification for which you are currently studying

Name of University, Polytechnic or College ______

Degree/qualification title ______

Subject(s) studied ______

______

Entry date ______

Approx. date of examinations______

Date results expected ______

Language of instruction ______

3. Professional or other qualifications

Please give details on a separate sheet if appropriate (see also question 5)

______

______

______

4. a. English language competency

Is your first language English? Yes  No 

If NO please list any English language qualifications:

English language qualification held ______

Obtained at ______

Date ______

Grade______

b. Dutch language competency

Is your first language Dutch? Yes  No 

c. Other languages:

Language / Spoken
Level of competency / Written
Level of competency

NB If your first language is not English you are required to obtain a satisfactory standard on an approved English language qualification before entering the University. Acceptable qualifications include TOEFL or its equivalent. Test scores obtained more than 3 years old are not normally accepted.

5. Particulars and dates of full-time employment

If you have a large amount of work experience/publications that cannot be fitted on to this form please enclose a curriculum vitae.

a. Home Country ______

______

______

b.Abroad

______

______

______

c. Practical/industrial experience and/or training

______

______

______

  1. Funding

If you will have a scholarship or grant for your period of study on this programme, please give details. If not, please state how you intend to finance yourself.

______

______

______

______

  1. References

Give names, titles and addresses of two referees. These should be people under whose guidance you have recently studied. One reference can be an employer from whom you have gained relevant work experience.

Name______Name______

Position______Position______

Address______Address______

______

E-mail______E-mail______

  1. Signature

By signing this form, you are declaring that the information you have provided is accurate and that no material information has been omitted. You are agreeing to abide by the University’s rules and regulations if accepted onto a programme.

Signature______Date______

MA Design

Project Proposal Form

Name______

Title of MA Proposal______

______

Statement in support of your MA proposal

1.Project proposal. Please describe the main subject area you wish to research, how you anticipate researching the subject and what you anticipate your outcomes will be (max. 400 words).

2. Motivation statement. Please provide information about your research interests and reasons for applying for the programme (max. 200 words)

Continued overleaf

I attach ______sheet(s) of additional information.

(Please indicate number of additional sheets attached in the space provided.)

Please include the following with your application form:

two passport-size photographs

a copy of your passport.

your curriculum vitae

authenticated copies of certificates and diploma’s (stamped and signed)

Portfolio on CD (a pdf or a jpg that can be easily opened on any computer platform).

-For applicants living in the Netherlands: portfolio in digital format or hard-copy (please send no originals)

-For overseas applicants only: portfolio in digital format (see requirements above)

Signature

By signing this form, you are declaring that the information you have provided is accurate and that no material information has been omitted. You are agreeing to abide by the University’s rules and regulations if accepted onto the programme.

Signature ______Date ______

Application MA Design 2009/2010- 1 -