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Emergency form - International Office - Faculty of Technology
Fields marked with * are mandatory
Personal information
First name
Surname
Student number
HvA-email adress
Phone number
Year of study
2021-2022
2022-2023
2023-2024
Programme
Make a choice
AVI - Aviation engineering
AVI - Aviation operations
BE – Built Environment
ENG - Engineering
FS - Forensic Science
LOG – Logistics
AM - Applied Mathematics
MS -Maritime Studies
Who to contact in case of emergency?
Parents
Partner
Friend
Other
Emergency contact information
Name emergency contact
Address emergency contact
Email address emergency contact
Phone number emergency contact
Information about your stay abroad
What will you do abroad?
Minor
Internship
Research
Work
Country
City
(Partner) university or company name
Date of departure
Date of return
Information about your insurance
Health insurance company
Health insurance number
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