Application form Incluusion Buddy Program - academic year 2022/2023

PERSONAL INFORMATION:

First Name: *

Last Name: *

Gender: *

Male

Female

Prefer not to say

Other

Date of Birth: *

dd/mm/yyyy

E-mailadres:
(if you have a UU email address, please fill that one in as MS Teams will be used for communication) *

STUDY INFORMATION:

Level: *

Bachelor

Master

PhD

Employee of the UU

Department or Faculty: *

Study Programme:

Study Year:

LANGUAGE SKILLS:

What languages do you speak? *

PARTICIPATION IN THE BUDDY PROGRAM:

For which block would you like to apply?
(you can select multiple options) *

Block 1: Monday 5 September 2022 (week 36)

Block 2: Monday 14 November (week 46)

Block 3: Monday 6 February (week 6)

Block 4: Monday 24 April (week 17)

The buddy training will take place on November 8th, from 14.30hrs to 18.00hrs. Are you able to attend? *

Yes

I don't know yet

We aim on matching two buddies with each refugee student. This of course depends on the number of applications from buddies and students, and alternatively groups of two buddies and two students can be formed. Therefore, if you sign up with a friend you will be matched together. If you sign up on your own, we will take care of the matching.

Would you like to sign up together with a friend? *

Yes

Namely:
(indicate name and email address of your friend)

Can you briefly explain why you would like to volunteer as a buddy? (max 200 words)

Taking your studies and private life into account, are you able to commit at least 2 hrs per week (mostly communicating via Whatsapp, Teams etc) and meeting up around once every two weeks? *

Are there any criteria that should be taken into account when selecting your buddy? *

Do you have any questions or comments?

DECLARATION:

“I agree that my personal data submitted here may be electronically processed and stored.
This should, however, be done exclusively for the internal organisation of the registrations.
I may at any time and without giving reasons request the deletion of my data.” *

Meer informatie over hoe Universiteit Utrecht met uw persoonsgegevens omgaat vindt u op www.uu.nl/privacy.

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