Application for a BIP at a university abroad

Please complete the application form below to apply for your participation in a BIP (Blended Intensive Programme) at a university abroad. We look forward to receiving your application.

Application data

Application for the following BIP*

Have you already been nominated for the BIP by your university?*

Yes.

No.

Please briefly explain your motivation for participating in this BIP.*

What existing knowledge/experience do you have in this field?*

Personal data

First name *

Last name *

Gender

Date of birth (DD.MM.YYYY) *

Nationality *

Email address *

Repeat email address to verify *

Current home address / mobile number

Street and house number *

Postal code *

City *

Country*

Mobile number (incl. country code, for example +41) *

Emergency contact

First name of your emergency contact *

Last name of your emergency contact *

How are you related to the emergency contact (e.g. mother, father, partner)? *

Email address *

Phone number *

Home address *

Information about your studies

At what level are you studying?*

Matriculation/student number *

Name of your study programme *

In which semester are you currently studying? (e.g. 3rd semester out of 6) *

Additional information

Is your host university, where the BIP is taking place, a partner of the EELISA alliance?*

Yes.

No.

Not sure.

Is there anything you would like to share with us regarding your application?

Completion of application

I confirm*

that before my departure, I will ensure with my insurance provider that my insurance coverage is sufficient during my stay abroad (accident and health insurance, liability insurance).

I confirm*

that I have made all statements truthfully.

Data protection at ZHAW: See data protection notice https://www.zhaw.ch/en/data-protection

I confirm*

that I have taken note of the data protection information.