EAN Application Form
Personal details
First Name
Your answer
Last Name
Your answer
Gender
Address
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Postal code (1234AB)
Your answer
City
Your answer
Date of birth
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E-mail address
Make sure you use your personal e-mail address, a university e-mail address will be inaccessible after you leave university!
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Mobile number
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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
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Travel plans
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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
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