Registration form for Ukrainian refugees
to register as a temporary Incluusion student

Personal Data

First name(s): *

Surname: *

Initials: *

Gender: *

Male		Female
Other		I don't want to answer this question

Date of birth: *

Place of birth *

Country of birth: *

Nationality: *

Email address: *

Phone number: *

Please fill out your current Dutch address below.
We do not take registrations into account if the address is not Dutch.

Street name *

House number:

Postal code: *

City: *

What applies to you? *

I am Ukrainian

I'm an international student from Ukraine

EDUCATION AND EXPERIENCE

At which Ukrainian university are you currently registered? *

What are you studying there? *

What is the level of your current study? *

Upload proof of your current registration at a Ukrainian university:
For instance, a picture or pdf of the registration for study year 2022-2023. *

I want to upload another document to proof my attendance at a Ukrainian university.

PRACTICAL MATTERS

Have you followed a course through Incluusion before?
A course in the summer from the Utrecht Summer School does not count. *

I am a new student

I have followed an Incluusion course before

Indicate your student number:
If you are new to the Incluusion program, you can leave this field open.

I understand that registering as an Incluusion student at Utrecht University only allows me to use the UU student facilities.
This means I have access to the library using my digital student card and I can book a spot to study quietly (if available).
I understand that this registration does not allow me access to educational programmes of the UU, neither bachelor or master.
I understand I will not receive study points through the UU with this registration. *

I hereby state that I agree with the privacy statement of Utrecht University. *

Do you have any comments or questions?

* = Input is required

Registration form for Ukrainian refugees to register as a temporary Incluusion student

Personal Data

EDUCATION AND EXPERIENCE

Registration form for Ukrainian refugees
to register as a temporary Incluusion student