REI-2015-01-01
Personal
General
First name
Last name
Gender
Birthday
Place of birth
Country of birth
Nationality
Contact
E-mail
Phone
Home address
Address
Zip code
City
State / Province
Country
Institutions
Institution
Scholarship info
Scholarship information
Title
Type
Main sector
Sub sector
Scholarship date
Start date
End date
Scholarship institutions
Institutions Flanders
Institution South
Supervisor Flanders
Supervisor Flanders
Supervisor South
Supervisor South
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Project info (automatically filled out)
Project title
Travel grants 2015 your institution
Project file number
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Administrator VLIR-UOS
Stijn De Roover
Main sector
Scholarship programme Sub sector
Scholarship programme Institutions Flanders
Institutions South
Mobilities
Place and date
Country of destination
City
Region
Institution
Estimated start stay
Estimated end stay
Place of stay
Real start stay (to be filled out after return)
Real end stay (to be filled out after return)
Follow-up (filled out by institution and VLIR-UOS)
Selection Status
Score by Vlir
Score by institution Flanders
Ranking institution Flanders
Positive remarks
Negative remarks
Selection round
Received scholarship
Application Form
Contact Address
Only needed if your contact address is not the same as your home address.
Address
City
ZIP code
State / Province
Contact
Tel/mobile (home/reserve)
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Bank Account
Bank account number (IBAN)
Experience in Development
Have you been to a development country before?
(If yes) Which country?
(If yes) What was the purpose?
(If other) Please specify
State other experience that is relevant to the assignment (eg voluntary work)
Statements
To what extent do the following statements apply to yourself? 1) Totally not applicable => 5) Fully applicable
Education
Institution
Level of training
Name of the training and current study programme (semester or year)
Study component
(If other) Please specify
Project Data
Give a short summary of your project (max 5 sentences)
Assignment and Results
What is the goal of your assignment in the selected country? (Distinguish between your goal with respect to your
studies and the goal of the institution where you will work)
What results do you expect to achieve at the end of your stay? (Distinguish between your results with respect to
your studies and the results for the institution where you will work)
What will you do to achieve those results? What does your role consist of exactly? Will you receive local or other
support? Explain.
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Development Relevance
Why and how did you select the destination and the assignment?
Point out how your field of study can establish an added value for a certain necessity of the country of your
destination.
State whether your assignment is part of another VLIR-UOS programme or another partnership (NGO, …) and
provide some extra information about this partnership. No
(If VLIR-UOS) Which VLIR-UOS programme?
(If other) Please specify
(If related to VLIR-UOS) Give the name or code of the project (ask your supervisor for more information)
What is the name of the organisation where you will conduct the assignment?
What is the type of the organisation where you will conduct the assignment?
(If other) Please specify
Describe the organisation where you will conduct the assignment.
How will the local institution utilise these results to contribute to the development of the place or region?
Preparations
Does your work build on the work of other students or researchers?
(If yes) Explain
What does the local promoter expect from you in terms of assignment preparation?
How will your Flemish supervisor support your assignment?
How have you prepared for your stay in the South and what further preparations will you make?
In what language will you conduct your assignment?
(If other) Please specify
Do the persons you will come into contact with speak this language? Do you have knowledge of specialist
terminology in this language?
Language Skills
Other
The Stay
How safe do you feel the region you are going to is? (See among other things the foreign affairs department
recommendations at www.diplomatie.be)
How is your stay planned? Provide a schedule for the whole period showing the assignment is feasible. Which
tasks will be conducted during which period of your stay?
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What have you agreed and what do you intend to agree with your local promoter about your stay? (E.g. housing,
transport, assistance in situ and possible related costs)
Where applicable, provide the names of other Flemish students you know – perhaps in another field of study or
from another institution – that will be active at the same local organisation at the same time.
Return
What do you plan to do with your experience when you return to Belgium? How will you share that experience with
others?
I think that’s
useful, but I
don’t have time
for this
I already did
I think that’s
useful, but it’s
nothing for me
I plan to do
this
I don’t
think
that’s
useful
Costs
Ticket
Visa
Travel Insurance
Accommodation costs
Other costs (eg medical costs, costs related to your assignment, ...)
Scholarship
Were you, during last academic year, entitled to a study scholarship from the Flemish Government?
Final Stipulations
Download and read the final stipulations
Do you agree with the final stipulations?
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