Postgraduate of Dutch As a Foreign Language in an Academic Context

Postgraduate of Dutch as a Foreign Language in an Academic context

APPLICATION FORM

To be filled out electronically and sent to [email protected]. Enter all information exactly as it appears on your passport. The information provided should be valid at least until 14 September 2015. We only accept applications that are complete.

Personal information

Surname:

First name:

Sex: Male / Female [Delete the incorrect answer]

Nationality:

Date of birth (day/month/year):

Place of birth:

Postal address

Street: Number:

Postal code: City, state:

Country:

Country Area Phone Telephone number: code: code: number:

Country Phone Mobile number: code: number:

E-mail:

Marital status: Single / Married / Other [Delete the incorrect answers]

Do you need a student visa? Yes / No [Delete the incorrect answer]

2015 – 2016 • Postgraduate of Dutch as a Foreign Language in an Academic context 2

Contact person in case of emergency

Surname:

First name:

Postal address

Street: Number:

Country:

Telephone Country Area Phone number: code: code: number:

E-mail:

Contact person in Belgium (not obligatory)

Surname:

First name:

Postal address

Street: Number:

Country:

Telephone Country Area Phone number: code: code: number:

E-mail:

Mother tongue:

Knowledge of any other languages:

Yes / No [Delete the incorrect I will stay with this contact person during my stay in Belgium: answer]

Language skills questionnaire

What is your mother tongue?

Was this the instruction language used at your secondary Yes / No [Delete the incorrect school? answer]

If not: what was/were the language/s of instruction at your secondary school?

Which foreign language(s)1 did you study?

a. at school, the language(s) is/are mentioned on my diploma

b. at school, I include a document to proof this Where did you study them? c. I took a course of minimum 50 hours and I include a certificate of this course

[Delete the incorrect answers]

a. It is a foreign language I learned at school.

b. I took an English course.

Where did you learn English? c. It is my mother tongue.

d. It was the language of instruction at my secondary school.

[Delete the incorrect answers]

1 Foreign languages are languages that are neither your mother tongue nor the language of instruction used in your secondary school.

Foreign languages European language 1 European language 2 European language 3 European language 4 (if applicable) (if applicable) (if applicable)

What languages did you study? Where did you study this language? When did you study this language? How many hours of class did you take approximately? Do you still use this language? In which situations?

Please indicate your knowledge of the language on CEFR- scale (see Appendix): Listening A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 [Delete the incorrect answers] Reading A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 Spoken Interaction A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 Written interaction A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 Spoken Production A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 Written Production A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2 A1 – A2 – B1 – B2 – C1 – C2

Academic information

Secondary school

Name and address of the institution:

Name of studies:

Diploma and/or certificate obtained:

Date of graduation (day/month/year):

Post-secondary education or university studies (not obligatory)

Name of studies:

Diploma or certificate obtained:

Other formal studies (not obligatory)

Name of studies:

Diploma or certificate obtained:

Professional experience (not obligatory)

Period:

Name and address of employer:

Sector:

Job title:

Description of responsibilities:

Motivation statement

Why do you wish to study in the Postgraduate of Dutch as a Foreign Language in an Academic context? What interests you about this area of study? (Your answer should be minimum 50 words.)

What do you want to study after the Postgraduate of Dutch as a Foreign Language in an Academic context? At which Dutch-speaking university or institution for higher education? Why did you choose this study? (Your answer should be minimum 50 words.)

Describe the qualities and skills which will help you to succeed in this course. How could you demonstrate these? You may include personal and educational achievements. Tell us about experiences, qualities and skills you have that you think may be relevant to this application. (Your answer should be minimum 100 words.)

Additional information relevant for the application

Confirmation

I confirm that I have handed in: Yes / No [Delete the incorrect a copy of my passport or identity card; answer] Yes / No [Delete the incorrect a legalised copy of my diploma of secondary education; answer] Yes / No [Delete the incorrect the transcript of records (diploma of secondary education); answer] (if not mentioned on my diploma of secondary education) Yes / No [Delete the incorrect the proof that I studied a European language as a answer] foreign language

(if applicable) copies of my other diplomas, degrees and Yes / No [Delete the incorrect certificates; answer] Yes / No [Delete the incorrect the advance fee of 1,500 EUR. answer]

I confirm that the information I have given on this application form is complete and accurate. I am aware that this information will not be shared with a third party.

Date (day/month/year):

2015 – 2016 • Postgraduate of Dutch as a Foreign Language in an Academic context 2018 年 1 月 9 日 - 8

Appendix: Self-assessment grid CEFR-scale (Common European Framework of Reference for Languages: Learning, Teaching, Assessment) Source: http://europass.cedefop.europa.eu/LanguageSelfAssessmentGrid/en

European language levels - Self Assessment Grid

A1 A2 B1 B2 C1 C2 I can understand familiar I can understand phrases I can understand the main points I can understand extended I can understand extended I have no difficulty in words and very basic and the highest frequency of clear standard speech on speech and lectures and follow speech even when it is not understanding any kind of phrases concerning vocabulary related to areas familiar matters regularly even complex lines of clearly structured and when spoken language, whether live myself, my family and of most immediate personalencountered in work, school, argument provided the topic is relationships are only implied andor broadcast, even when U immediate concrete relevance (e.g. very basic leisure, etc. I can understand the reasonably familiar. I can not signalled explicitly. I can delivered at fast native speed, surroundings when personal and family main point of many radio or TV understand most TV news and understand television provided. I have some time to Listening n people speak slowly and information, shopping, local programmes on current affairs or current affairs programmes. I programmes and films without get familiar with the accent. d clearly. area, employment). I can topics of personal or professional can understand the majority of too much effort. e catch the main point in interest when the delivery is films in standard dialect. r short, clear, simple relatively slow and clear. s messages and announcements. t I can understand familiar I can read very short, I can understand texts that consist I can read articles and reports I can understand long and I can read with ease virtually a names, words and very simple texts. I can find mainly of high frequency everyday concerned with contemporary complex factual and literary all forms of the written n simple sentences, for specific, predictable or job-related language. I can problems in which the writers texts, appreciating distinctions of language, including abstract, d example on notices and information in simple understand the description of adopt particular attitudes or style. I can understand structurally or linguistically i posters or in catalogues. everyday material such as events, feelings and wishes in viewpoints. I can understand specialised articles and longer complex texts such as manuals, advertisements, personal letters. contemporary literary prose. technical instructions, even when specialised articles and literary n Reading prospectuses, menus and they do not relate to my field. works. g timetables and I can understand short simple personal letters.

2015 – 2016 • Postgraduate of Dutch as a Foreign Language in an Academic context 2018 年 1 月 9 日 - 9

A1 A2 B1 B2 C1 C2 I can interact in a I can communicate in I can deal with most situations I can interact with a degree of I can express myself fluently and I can take part effortlessly in simple way provided simple and routine tasks likely to arise whilst travelling in anfluency and spontaneity that spontaneously without much any conversation or discussion the other person is requiring a simple and area where the language is makes regular interaction with obvious searching for and have a good familiarity prepared to repeat or direct exchange of spoken. I can enter unprepared native speakers quite possible. expressions. I can use language with idiomatic expressions and rephrase things at a information on familiar into conversation on topics that areI can take an active part in flexibly and effectively for social colloquialisms. I can express slower rate of speech topics and activities. I can familiar, of personal interest or discussion in familiar contexts, and professional purposes. I can myself fluently and convey finer Spoken and help me formulate handle very short social pertinent to everyday life (e.g. accounting for and sustaining formulate ideas and opinions shades of meaning precisely. If S interaction what I'm trying to say. exchanges, even though I family, hobbies, work, travel and my views. with precision and relate my I do have a problem I can p I can ask and answer can't usually understand current events). contribution skilfully to those of backtrack and restructure e simple questions in enough to keep the other speakers. around the difficulty so a areas of immediate conversation going myself. smoothly that other people are k need or on very familiar hardly aware of it. i topics. n I can use simple I can use a series of I can connect phrases in a simple I can present clear, detailed I can present clear, detailed I can present a clear, smoothly- phrases and sentences phrases and sentences to way in order to describe descriptions on a wide range of descriptions of complex subjects flowing description or argument g to describe where I live describe in simple terms experiences and events, my subjects related to my field of integrating sub-themes, in a style appropriate to the and people I know. my family and other dreams, hopes and ambitions. I interest. I can explain a developing particular points and context and with an effective Spoken people, living conditions, can briefly give reasons and viewpoint on a topical issue rounding off with an appropriate logical structure which helps production my educational background explanations for opinions and giving the advantages and conclusion. the recipient to notice and and my present or most plans. I can narrate a story or disadvantages of various remember significant points. recent job. relate the plot of a book or film options. and describe my reactions. I can write a short, I can write short, simple I can write simple connected text I can write clear, detailed text I can express myself in clear, I can write clear, smoothly- simple postcard, for notes and messages. I can on topics which are familiar or of on a wide range of subjects well-structured text, expressing flowing text in an appropriate example sending write a very simple personal interest. I can write related to my interests. I can points of view at some length. I style. I can write complex holiday greetings. I can personal letter, for example personal letters describing write an essay or report, can write about complex subjects letters, reports or articles which fill in forms with thanking someone for experiences and impressions. passing on information or in a letter, an essay or a report, present a case with an effective Writing personal details, for something. giving reasons in support of or underlining what I consider to be logical structure which helps example entering my against a particular point of the salient issues. I can select a the recipient to notice and name, nationality and view. I can write letters style appropriate to the reader in remember significant points. I address on a hotel highlighting the personal mind. can write summaries and registration form. significance of events and reviews of professional or experiences. literary works.

2015 – 2016 • Postgraduate of Dutch as a Foreign Language in an Academic context