Application Form: Master in Industrial Management

Application Form
Master in
Your
picture
here
Industrial Management
Family name Katholieke
(surname):
Universiteit
Personal name Leuven
(given or first name):
Introduction
The detailed selection procedure and admission applicable for admission to the programme: Master in
requirements are described on the website: Industrial Management.
http://cib.kuleuven.be. This application form is only If directed to the address below, no administration fee
will be charged to the applicant.
Instructions
Complete one copy of this application form in full. All block letters (black ink). Incomplete or illegible
questions must be answered accurately. If a question applications may be rejected and cannot be
is not relevant answer "not applicable" or "NA". processed nor answered. If necessary use additional
Please complete the form in English. Answers must sheets of paper.
be legible, preferably typewritten or hand-written in
Documents to enclose
1. One notarized copy of your diplomas and 3. Document your proficiency in English. With an
transcripts of academic records (detailed list of original (! ) GMAT of 575 you will probably be
results per academic year and per course). The admitted. Otherwise include either an original (!)
grades obtained should also be mentioned. TOEFL, TOEIC or IELTS certificate. A TOEFL score of
"Notarized" means that the documents must be 90 is required (235 computer-based, 575 paper-
authenticated by an official authority of your country, based), 817 on TOEIC or 7 on IELTS. Or include proof
the educational institution that issued them or the that all your university studies were in English.
local Belgian diplomatic office. Add also a document
explaining the grading system of your country (e.g. It is also possible to have your English proficiency
comparing the grades to a numeric score). If you are tested in the “Centrum voor Industrieel Beleid” at
still preparing for an examination at the time of specific dates announced at the Centre’s website.
application, you are requested to forward – as soon 4. Two passport sized photographs.
as the results are published – a certificate attesting
the results to the same address as this application 5. A short text of one page length explaining the
form. reasons why you would like to attend the programme
and what specialisation area(s) you are interested in.
2. A translation of the diplomas in Dutch, English,
French or German. 6. For non-EHOR citizens: two letters of
These documents must be authenticated by an official recommendation under closed envelope (preferably
authority of your country (or by the Belgian diplomatic from employer or academician). This recommendation
office). form can be downloaded from our website.
Deadline for submission of your application

For non-E.U. residents: April 1. For E.U. residents Return the completed application forms to:
preferably before July 1 (final deadline September 1). Centrum voor Industrieel Beleid
Katholieke Universiteit Leuven
Celestijnenlaan 300A Bus 2422
B-3001 HEVERLEE-(LEUVEN)
Belgium
Tel: ++ / 32 / 16 / 32.25.67
Fax: ++ / 32 / 16 / 32.29.86
e-mail: info@cib.kuleuven.be
Website: http://cib.kuleuven.be
CIB-Appl-2010-05-26 Application form page 1 / 9

Master in Industrial Management
1. Personal information
Please note: write your name as it appears on your passport and in exactly the same way on this form and
throughout the application procedure, otherwise you might experience difficulties when applying for a visa or plane
ticket.
Family name (surname):
Maiden and/or any other names that

may have been used on documents:
Personal name (given or first name):
Sex : [male/female]
Place of birth : [country, town]
Date of birth : [dd/mm/yyyy]
Current nationality:
Permanent address (as mentioned in your passport)

Street, number (box):
Postal code: City, State:
Country:
Telephone:
[country code - area code – number]
Current Postal address (for correspondence regarding this application, especially in the
period April - September
Country:
Telephone:
Fax:
E-mail:
Contact person in case of emergency

Family name (surname):
Personal name (given or
first name):
Country:
Telephone:
Fax:
E-mail:
Application form page 2 / 9

Marital Status
Married single divorced widowed
Family
Family name Personal name Date of birth Sex
Place of birth
(surname) (given or first name) (dd/mm/yy) (m/f)
Spouse
Child
Child
Child
Child
Note concerning the e-mail addresses: experience has shown that e-mail is an excellent way of communicating
with the applicants. Please add an e-mail address to your personal data, if possible. You could also add the e-mail
address of a friend, a secretariat, etc.
2. I am applying for
an international advanced academic programme taught in English
I will attend the Master Programme

Full Time (one year) Part Time (two years or more)
Please specify over how many years you intend to
spread the programme: ………………… years.
3. Academic Information
Language skills
Mother tongue:
Other languages: indicate with a number from 1 to 5 the degree of your proficiency:
5 = native speaker, 4 = excellent, 3 = good, 2 = fair, 1 = none
Dutch English French German … …
Speaking
Writing
Reading
Understanding

Proficiency in English
Did you receive any part of your
yes no
education in the English language:
If so, which part: secondary university ............................................
Do you have an official GMAT yes no

certificate: GMAT score: ............. date of this test: ...........................................
Do you have an official TOEFL yes no

certificate: TOEFL score: ............. date of this test: ...........................................
Do you have another English language

Name of the test: ……………… score: ...............................................
certificate (TOEIC or IELTS):
Do you have an English language

certificate of the “Centrum voor yes no
Industrieel Beleid” ?
Do you have the intention to take a yes no

“Centrum voor Industrieel Beleid” test
for an English language certificate ? When ................................................................................................
Please, add the English language certificates to your file.
Post-secondary education or university studies (chronological)

Period
Name and address of the Language Qualifications Grade/
From (dd/mm/yy) Name of studies
institution used obtained results
To (dd/mm/yy)
Title and subject of thesis (also mention the results or grade obtained):

Other formal studies, workshops, etc. (chronological)
Period
Name and address of the Language Qualifications Grade/
From (dd/mm/yy) Name of studies
institution used obtained results
To (dd/mm/yy)
List of publications: use a separate sheet if applicable.
4. Professional experience (if applicable)

Research and teaching experience (chronological) (use a separate sheet if necessary)
Period Name and address of the institution Name of subjects taught and/or description of
From (dd/mm/yy) Name of supervisor research conducted, job title
To (dd/mm/yy) Telephone and fax numbers (Please distinguish between research and teaching jobs)
Non-academic professional experience (chronological) (use a separate sheet if necessary)
Period Name and address of the institution Position (job title) and
Sector (education,
From (dd/mm/yy) Name of supervisor description of
industry, NGO, etc.)
To (dd/mm/yy) Telephone and fax numbers responsibilities

5. Extracurricular record (if applicable)

List extracurricular activities (school or community) in which you have been involved (use a separate sheet if
necessary, but do not exceed one page of text).
6. Study financing information

To be filled out by citizens from non-EHOR countries only
Applicants are required to provide evidence of sufficient funds to cover academic and living expenses. You must
certify for the Belgian government that you will have a minimum income of at least 620 EUR per month for the
entire duration of the intended study period in Belgium. If you intend to bring your family to Belgium, you must
provide evidence of a higher income.
If applicable, list the scholarships and grants you received previously (in your own country
and/or abroad):
Period
Name and address of the organization that Studies:
From (dd/mm/yy)
issued the scholarship (institution, field of studies)
To (dd/mm/yy)
Are you applying for a scholarship in order to attend this programme? yes no
name of scholarship agency (institution,

etc.):
address and contact person of the

scholarship agency:
If so:
amount:
period covered:
did you receive confirmation that you

yes no (please include a copy of the grant.)
will be granted this scholarship?
The “Centrum voor Industrieel Beleid” does not award grants to study at the Centre.

What other resources of funds could you dispose of during your study project?
Source Amount (in EUR) / month
Self support EUR
Family or individual sponsors EUR
Government, company or other

EUR
scholarships/grants
... EUR
... EUR
Do you intend to bring your spouse and/or children to Belgium? yes no
If so When would they travel to Belgium?
7. Additional questions
Where and how did you first hear about the programme?
If you want to follow the programme Part Time (two years or more), please explain here why.
Have you applied for this programme before? yes no
what was the outcome of the application:
If so

Contact Persons
If you are an EHOR citizen you should name at least two persons who would be willing to give us more information
concerning your previous studies.
(Non-EHOR citizens: two letters of recommendation (under closed envelope) should be included. This
recommendation form can be downloaded from our website).
Contact address,
Name of contact person Your relationship to this person
Telephone and fax numbers, E-mail address
Motivation
Describe in one page of text your reasons for wishing to attend this programme. Mention also what field of study
you would like to select.
The fields of study are:
• Environment, Safety and Energy
• Information and Communication Technology
• Production and Logistics Management
Important remark: When admitted to the MIM programme you are NOT automatically admitted to the field of study
of your choice! It is the faculty of the field of study who will make the final decision on your admission to the field.
You can find more information about the specific prerequisites on our website under “programme information”.
Final Check
Please check off the items on the list below:
Explanation (why is it not included and when will it
Check List Included?
be sent)
Transcripts of the different years of yes no
previous (undergraduate) study
programmes:
Notarized copy of your diplomas: yes no
Official TOEFL OR GMAT certificate or yes no

equivalent:
Photographs (two): yes no
A well written motivation letter: yes no
Two recommendation letters (for non- yes no

EHOR citizens only):
Every relevant question has been yes no

answered:
Please be accurate and avoid any mistake. An incomplete application form or an application form with several
mistakes will reflect badly on your capacity to study at the Centrum.

Declaration by the applicant (to be completed by all applicants)

I hereby declare on my honour that this information is correct and complete and that I shall immediately inform the
“Centrum voor Industrieel Beleid”, Katholieke Universiteit Leuven when there are any changes in my situation.
I hereby agree that any false statement I make in this application shall result in immediate cancellation of my
application.
I also acknowledge that I claim no financial or material aid from K.U.Leuven during my studies.
For non-EHOR citizens: two letters of recommendation (under closed envelope)

should be included. This recommendation form can be downloaded from our
website.
Name: signature
Date:
The collected data will be used in connection with the didactic and social re lations between the Univ ersity and its students, as
we ll as for research projects relativ e to these relations. The data may be used to supply selectiv e information to third parties, if
and when this serv es the interests of the students inv olv ed.
You may avail yourself of your rights of consultation, as prov ided by article 10 of the Law of December 8, 1992, by applying in
writing to the V ice-President for Student Affairs, Oude Markt 13, 3000 Leuven.
Furtherm ore, you are entitled to access the Public Record, in accordance with article 18 of the same la w.

Application Form: Master in Industrial Management

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Application Form

Deadline for submission of your application

CIB-Appl-2010-05-26 Application form page 1 / 9

Family name (surname):

Maiden and/or any other names that

Personal name (given or first name):

Place of birth : [country, town]

Date of birth : [dd/mm/yyyy]

Permanent address (as mentioned in your passport)

Postal code: City, State:

Postal code: City, State:

Contact person in case of emergency

Postal code: City, State:

Application form page 2 / 9

I will attend the Master Programme

Dutch English French German … …

Application form page 3 / 9

If so, which part: secondary university ............................................

Do you have an official GMAT yes no

Do you have an official TOEFL yes no

Do you have another English language

Do you have an English language

Do you have the intention to take a yes no

Please, add the English language certificates to your file.

Post-secondary education or university studies (chronological)

Application form page 4 / 9

List of publications: use a separate sheet if applicable.

4. Professional experience (if applicable)

Non-academic professional experience (chronological) (use a separate sheet if necessary)

Application form page 5 / 9

5. Extracurricular record (if applicable)

6. Study financing information

name of scholarship agency (institution,

address and contact person of the

did you receive confirmation that you

Application form page 6 / 9

Self support EUR

Family or individual sponsors EUR

Government, company or other

Do you intend to bring your spouse and/or children to Belgium? yes no

If so When would they travel to Belgium?

Have you applied for this programme before? yes no

what was the outcome of the application:

Application form page 7 / 9

Official TOEFL OR GMAT certificate or yes no

Photographs (two): yes no

A well written motivation letter: yes no

Two recommendation letters (for non- yes no

Every relevant question has been yes no

Application form page 8 / 9

Declaration by the applicant (to be completed by all applicants)

For non-EHOR citizens: two letters of recommendation (under closed envelope)

Application form page 9 / 9

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