Registration form for research internship

Applications for internships abroad can be submitted by Faculty of Medical Sciences/UMCG students only.
Name*
First name Surname
E-mail address*
Enter e-mail address Confirm email address
Address*
Postcode*
Place of residence*
S-number*
Specification*
Academic year*

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Budget
A sound budget for the internship that itemizes all costs and income, including the present De Cock-Hadders Foundation fund application
Cost type*
Amount*
Applied for from De Cock-Hadders Foundation*
Applied for or recently obtained from elsewhere*
Cost type
Amount
Gevraagd aan De Cock-Hadders
Applied for or recently obtained from elsewhere
Kostensoort
Bedrag
Applied for from De Cock-Hadders Foundation
Applied for or recently obtained from elsewhere
Kostensoort
Bedrag
Applied for from De Cock-Hadders Foundation
Applied for or recently obtained from elsewhere
Kostensoort
Bedrag
Applied for from De Cock-Hadders Foundation
Applied for from De Cock-Hadders Foundation

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Name of applicant*
Signature of applicant*
Max. file size: 64 MB.
Date*
MM slash DD slash YYYY
Name of supervisor*
Signature of applicant*
Max. file size: 64 MB.
Date*
MM slash DD slash YYYY
* As an alternative to a digital signature from your supervisor, please include a copy of the letter signed by your supervisor, in which they state that they have read your application and have approved the content. This copy can be uploaded to the above box.

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Terms and conditions*
I have completed this form truthfully and I agree to the terms and conditions.
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Applications for internships abroad can be submitted by Faculty of Medical Sciences/UMCG students only.