Before completing this form, please review the admission requirements for the chosen course/program of study on the HSBM website. Please write in BLOCK CAPITALS using black ink and complete all sections. Section One: Personal Details Please enter your name exactly as it appears on your passport or other official document. GENDER: FAMILY NAME: Male = M, Female = F DATE OF BIRTH: FIRST NAME: (DD/MM/YYYY) st MIDDLE NAME(S): 1 CITIZENSHIP: PREFERRED NAME: 2 CITIZENSHIP: nd Section Two: Contact Details HOME ADDRESS: CORRESPONDENCE ADDRESS (if different): CITY: CITY: POSTAL / ZIPCODE: POSTAL / ZIPCODE: STATE / PROVINCE: STATE / PROVINCE: COUNTRY: COUNTRY: TELEPHONE: + MOBILE: + EMAIL ADDRESS: Page 1 of 5 HSBM ADM 02-2014 Section Three: Entry Requirements Please attach the following documents with your application. ENGLISH LANGUAGE CERTIFICATE: ACADEMIC TRANSCRIPT(S): REASON FOR MISSING DOCUMENT(S): Please send only copies of the original document(s). Please do NOT send originals. Section Four: Additional Information Please indicate Y (yes) or N (no) to the following questions? Y N Do you have a physical disability that requires you to have Y support during your academic studies? N Have you ever been convicted of a criminal offense? Section Five: Selection of Study Please mark the Program or Diploma to which you are applying to with an X. Degree Programs BSc in Accounting and Control BSc in Banking and Finance BA in Business Management BA in Human Resource Management BA in Corporate Communication BA in Health and Environmental Sciences BA in International Marketing BA in International Relations BA in Hotel & Resort Management Diploma in Business Management Diploma in Information Technology Diploma in Corporate Finance Diploma in English Language Page 2 of 5 HSBM ADM 02-2014 Diploma in Hotel Management MBA in Marketing MBA in Finance MBA in Human Resource Management MBA in Accounting Doctor in Business Administration PhD in Leadership Section Six: Administration Fee The Hague School of Business and Management applies a € 200 non-refundable administration fee to all Applications. Please review the terms and conditions online at www.hsbm-thehague.com prior to submitting your application. Applicants should make sure their names and course field are clearly written when making payments. Please make the payment directly to: Beneficiary: Stichting The Hague School of Business and Management Account No.: 7067486 IBAN: NL19INGB0007067486 Swift Code: INGBNL2A Bank Address: ING Bank The Hague, The Netherlands Section Seven: Personal Declaration Page 3 of 5 HSBM ADM 02-2014 Once you have completed this application form, please read the following statements carefully. By signing this application form you confirm your acceptance of these statements. If you do not sign this form, we cannot process your application. I confirm that the information I have provided on this application form is (to the best of my knowledge) true, accurate, current and complete; and I agree to notify The Hague School of Business and Management promptly if any information contained on this application form should change. I confirm that all supporting work submitted as part of this application is entirely my own original work, except where clearly indicated otherwise, and does not include any plagiarized materials. PLEASE NOTE: All admissions decisions taken by The Hague School of Business and Management rely on the statements made on the application form and in the supporting materials supplied by you and your referees. This information will be held and used for the purpose of processing your application for study. If The Hague School of Business and Management believes that any information or statement contained on your application form may not be true, accurate, current and complete, or that any material submitted in support of your application may not be entirely your own original work, except where clearly stated otherwise, it may take any necessary steps to verify that information or statement, or to confirm that any supporting material is entirely your own original work, except where clearly stated otherwise. • I consent to the collection, processing, sharing and use of relevant personal data by The Hague School of Business and Management for the purposes of processing my application for study is subject to the provisions of the Data Protection Act 1998. • I understand that such personal data may be used and shared with third parties, some of which may be located overseas (including outside the European Economic Area), for the purposes of verifying my identity, qualifications, work experience, references and any submitted work. • I understand that The Hague School of Business and Management will normally only discuss my application with me, unless I have specified otherwise. • I understand that if any information or statement provided on or to support this application form is not true, accurate, current and complete, or any supporting material is not entirely my own original work, except where clearly stated otherwise, The Hague School of Business and Management may process and use this fact as relevant personal data. Such data may be used and shared with third parties, including Higher Education institutions, some of which may be located overseas (including outside the European Economic Area), to the extent necessary for the purpose of preventing fraudulent or dishonest applications for study, funding and/or visas. • I understand that if I become a registered recognised student, any personal data collected by The Hague School of Business and Management as a result of my application will form part of my student record. Please sign below to confirm acceptance of these statements NAME: SIGNATURE: DATE: Please scan and email your completed application to: [email protected] Or deliver your Application in one of HSBM regional Offices Page 4 of 5 HSBM ADM 02-2014 Page 5 of 5 HSBM ADM 02-2014
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