(Leave
blank - only to be filled in by the registration office!)
Geldeingang
Eingangsstempel
Haushaltsbescheinigung
Krankenversicherung
Passfoto
ggf. Exma
Foto an RZ
If you have been registered at University of
Hildesheim already: please indicate your former
student number.
Enrollment form
For (please mark as appropriate)
winter term 20__/___
Program:
Bachelor
summer term 20__
Master
Application Number (as printed on your admission notice):
In case you have statutory health insurance:
Registration number of your health
insurance:
Your personal insurance number:
Please observe the following:
Please fill in this form in block letters in a clear and
readable way; in order to indicate the corresponding key
code, please use the key table attached.
If no existing key is appropriate, please write in plain
language.
Legal basis for the collection of data:
Enrollment regulations of University of Hildesheim and the
law on statistics for universities (in its actual version).
The registration office of the University of Hildesheim is
responsible for ensuring compliance with the law of personal
data in Lower Saxony (in its actual version).
Please write only in the provided boxes, starting from the left;
you may shorten entries in a reasonable way, if a box is too
narrow.
1.
N am e
2.
S ur n am e
3.
B i r t h N am e
4.
Place of Birth
5.
D at e of B i r t h
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6.
S e x (m = male, f = female)
7.
N at i on a l i t y
Plain
language:
(Please enter the international license plate country
code, see key table no. 9)
Nationality
8.
C u r r ent pl a c e o f r e si d e nc e: H o m e co u n t r y
Germany (= I) or another country (= A)?
If Germany, please indicate the state (see key table no. 8)
If another country, please indicate its international license plate country code (see key table no. 9)
Current place of residence / Home address:
9.
N am e o f t h e st r e et an d st r e et n um b er
1 0. P o st del i v er y o pt i on s
(e.g. “care of Mr. / Ms.…”)
1 1. Z i p co d e
1 2. C i t y
1 3. P ho n e ( ar e a co d e, c al l n u m b er )
S e m e s t e r a d d r e s s i n G e r m a n y (if already known)
14.
N am e o f t h e st r e et an d st r e et n um b er
1 5. P o st del i v e y o p t i o n s
(e.g. “care of Mr. / Ms.…”)
1 6. Z i p co d e
1 7. C i t y
1 8. S em e st er Ad d r e s s i s r e q u i r ed t o b e i n
G er m an y ( = I )
(Delivery outside Germany is not possible!)
I
1 9. P l e a s e i n d i c at e t h e n u m b er o f t h e
l i c e n s e pl at e o f yo ur s em e st er
ad d r e s s
(see key table no. 8)
2 0. P ho n e ( ar e a co d e, c al l n um b er )
2 1. P o st al d e l i v er i e s sh o u l d g o t he
following:
Current place of residence / Home address
or
Semester address in Germany
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22. Program you enroll in
a) Degree of the program you enroll in
(see key table no. 1)
b) Subject of the program you enroll in (see key table no. 2)
c) Semester you enroll in (as printed in your admission)
d) Type of the program you enroll in (see key table no. 3)
a)
Degree
b)
Subject of study
c)
Semester
d)
Type of
progra
m
1. Subject
2. Subject
3. Subject
4. Subject
5. Subject
Information on prior vocational training
23.
Did you complete a vocational education (yes = y / no= n)?
No 24 – 27 is only to be filled in if you have been registered at a German University already in the past!
Information on prior University studies in Germany
24.
At which German university did you register first?
Plain language:
(Please also indicate its location code, key table no. 5,
nd
2 column)
25. What kind of university?
(see key table no. 5, 3rd column)
26. Semester of first registration at a university of the Federal Republic of Germany
(e.g. winter term 2013/2014 = WS13, summer term 2014 = SS14)
27. How many semesters – including the first term – have you been studying at a German university in
total (incl. practical semesters and semesters on leave as well as semesters that have taken place
in the former GDR)?
Thereof, how many…
- semesters on leave ?
- practical semesters (after starting your studies) ?
No 28 is only to be filled in if you have been studying outside of Germany in the past!
28. I n f o r m a t i o n o n p r i o r U n i v e r s i t y s t u d i e s o u t s i d e G e r m a n y
a)
In which country did you study?
Please enter the international license plate country code of the country in which you have
been studying (e.g. Iran = IR).
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b)
How many months did you study outside Germany?
(1 semester = 6 months)
c)
Please indicate the kind of studies outside Germany (1 = referring to the current studies, 2 =
not referring to the current studies, 3 = studies related stay abroad)
If you studied in more than one country outside Germany, please provide answers to questions a), b) and c) above in
the following table:
a)
b)
c)
1. Country
2. Country
3. Country
Voluntary additional information:
In case of physical disability you can indicate here voluntarily that you cannot attend lectures without assistance.
The university will endeavor to provide the necessary means within the possibilities given.
I am (please check)
Blind/visually handicapped
Deaf/hard of hearing
Wheelchair user
You may contact Dr. Petra Sandhagen, our senate representative of handicapped students or students with chronic
diseases; she can provide more information about studying with handicaps.
Phone: +49 5121 883-10968
E-Mail: [email protected]
Statutory Declaration
I apply for enrollment in accordance with the information provided in this form. I declare that all information provided is
complete and correct. I am aware of the fact that false and incorrect statements intentionally given are illegal and –
even if found out at a later point of time – enrollment will be cancelled. In addition, I assure that all information
regarding prior degrees and study periods are correct.
At no point in time in my prior University studies I did finally fail in a program similar or closely related to the one I enroll
in.
Place, Date
Signature
(Enrollment requires a handwritten signature. For underage students, the signature of a legal guardian is required.)
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