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LAS course enrollment form
First Name
*
Last Name
*
Initials and last name to be printed on the certificate
*
Home address
(street + nr, zip code, city)
*
Phone
*
Email
*
Place of birth
*
Country of birth
*
Date of birth
*
dd-mm-jjjj
Student or P number (if applicable)
Academic education
Title of Bachelor
*
Start date Bachelor
*
End date Bachelor
*
Name of university where Bachelor degree was obtained
*
City of university where Bachelor degree was obtained
*
Title of Master
*
Start date Master
*
Master finished?
*
yes
no
End date Master
*
Name of university where Master degree was or will be obtained
*
City of university where Master degree was or will be obtained
*
PhD?
*
No
PhD student
PhD degree
Info on PhD topic
Employment
Working at the facility
FSE
FMW-UMCG
Other
No registration without a cost center (UMCG/RUG) or invoice address (external participants)!
Costs for UMCG/RUG is 525 euros, fee for external participants is 2085 euros.
Cost center/kostenplaats
(this is a number, not a department name)
*
Invoice address
*
Reference number for invoice (if applicable)
Research group
*
Supervisor
*
Preferred course date
*
September 2025 (1st-19th)
January 2026 exact dates tbd
September 2026 exact dates tbd
Please select the species you will work with after obtaining the license
*
Mouse
Rat
Guinea pig
Rabbit
Fish
Poultry
Birds in captivity
Free living birds
Other
If other, please explain
Upload Bachelor diploma in original language and english (together or as separate files)
*
Upload Master diploma in original language and english (together or as separate files)
*
Upload Bachelor gradelist in original language and english
(together or as separate files)
*
Upload Master gradelist in original language and english
(together or as separate files)
*
Optional other document
Optional other document
Optional other document
Optional other document
Please email cdp-cursus@umcg.nl if you need any assistance filling out this form.
*
=
Invoer verplicht
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