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    *Semester:

    *First name:
    *Last name:
    *Address:
    *ZIP-code:
    *City:
    *Country:

    *Phone:
    *Email:

    *Date of birth:

    *Gender:
    Pronouns:

    *Room:
    Preference:

    *Reason for application:
    *Schooling, education & other occupation:
    *Plans for further education:
    Medical condition or handicap to be taken into account during the stay:
    *Name, address and phone number of relative (in case of illness):

    Miscellaneous:
    *How will the stay be financed:
    Remarks: