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