EAN Application Form
Personal details
First Name *
Last Name *
Gender *
Address *
Postal code (1234AB) *
City *
Date of birth *
E-mail address *
Make sure you use your personal e-mail address, a university e-mail address will be inaccessible after you leave university!
Mobile number *
LinkedIn page (URL)
(if available)
Details regarding Extensus
Member of Extensus *
In what year did you become a member of Extensus?
(when applicable)
Were you an active member within Extensus?
(when applicable, select all that apply to you)
Honours graduation details
Year of BSc graduation *
University *
Bachelor study programme *
Network details (all optional)
What are your plans for next year?
Master programme
Career plans
Travel plans
What would you like to achieve within the next five to ten years?
Dreaming is allowed. ;-)
Payment details
Account holder *
Authorization *
Terms & Conditions *
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