APPLICATION FORM COVER/FRONT PAGE/INVITATION/ANNOUNCEMENT
Cover: cover of the thesis Front page: black and white copy of the cover, following the cover Invitation: required item to receive the bonus Announcement: After the approval of the PhD student and the UHasselt promoter, the Communication and Marketing office will send the digital version of the announcement to all faculties/schools.
!!! ATTENTION !!!
Submission of this form: at least 10 working days before printing the proof of the thesis Only fully completed form can be processed Send this form to phd@uhasselt.be with the subject: ‘Application form cover – first name, last name – date of defence’ If required information in this form is unknown, please consult your ‘My Doctoral file) (‘MDF’) or contact your promoter/faculty. Administrative Director/contact person per faculty: Faculty of Architecture and Art: Christel Heyninckx/ Inge Lens Faculty of Business Economics: Liesbeth Celis/ Marleen Cupers Faculty of Medicine and Life Sciences: Katherine Nelissen/ Véronique Pousset Faculty of Engineering Technology: Machteld Schots/ Diana Olislagers Faculty of Law: Marijke Huber/ An Vranken Faculty of Rehabilitation Sciences: Kurt Vanbockryck/ Ellen Pipers Faculty of Sciences: Isabel Thys/ Lize Moors School of Educational Studies: Heidi Gielen/ Jannick Geuens School of Transportation Sciences: Edith Donders/ Kristel Hertogs School of Social Sciences: Ilse Peters/ Vicky Vanhille For a joint PhD (in collaboration with another university): add the signed joint PhD agreement to this form + the logo of the 2nd university in attachment to the e-mail (format: .jpeg, .eps or .ai) In case of a joint supervision (in collaboration with another institution such as; PXL, Fachhochschule, …): add the signed agreement to this form + the logo of the 2nd institution in attachment to the e-mail (format: .jpeg, .eps or .ai) Please always use the correct titles (according to the style guide) with the names of the promoter(s) and/or co-promoter(s) and the correct affiliation(s).

GENERAL INFORMATION THESIS/DEFENCE
Personal information:	Surname: First name: M / F / X:
Thesis A depot number must be requested with Patrick Carmens	Depot number: Estimatet total number of pages thesis: ☐<200 ☐Estimated pages if >200:
Public defence	Day and date: Room: Time: Link for digital live-stream:
COVER/FIRST PAGE
Language of the cover? The cover is written in the same language as the thesis	☐ Dutch ☐ English
Information PhD: These data must correspond with the data in your My Doctoral file *: Please use the correct titles (see style guide1, no deviation possible). For example: Dutch: Prof. – dr. English: Prof. – Dr Add affiliation(s): !!!a change of affiliation needs to be requested and approved upfront at the faculty!!! With a joint PhD or a joint supervision, both the UHasselt logo (and if applicable the tUL logo) + the logo of the partner university / institution are included on the cover. The joint PhD or joint supervision agreement must be attached to this application form.	Type of PhD ☐ UHasselt/tUL PhD ☐ Joint PhD Title thesis: Promoter*: Co-promoter(s)*: Joint PhD extra information: Official name 2nd university 2nd promoter*: Joint supervision extra information: Official name 2nd institution
Indicate the discipline in which you will defend at UHasselt (max. 1): (Dutch abbreviation of the faculty/school) * The transnational University Limburg (tUL) is a cooperation between Hasselt University (Belgium) and Maastricht University (the Netherlands) and can be considered as one university with a home base in each country (http://www.tul.edu/).	Faculty of Architecture and Arts ☐ Doctor of Architecture ☐ Doctor of Audiovisual and Visual Arts ☐ Doctor of Tourism Faculty of Business Economics ☐ Doctor of Business Economics ☐ Doctor of Tourism Faculty of Medicine and Life Sciences ☐ Doctor of Medical Sciences ☐ Doctor of Biomedical Sciences (tUL*) ☐ Doctor of Nursing Science ☐ Doctor of Tourism Faculty of Engineering Technology ☐ Doctor of Engineering Technology ☐ Doctor of Tourism Faculty of Law ☐ Doctor of Law (tUL*) ☐ Doctor of Tourism Faculty of Rehabilitation Sciences ☐ Doctor of Rehabilitation Sciences and Physiotherapy ☐ Doctor of Rehabilitation Sciences ☐ Doctor of Occupational Therapy ☐ Doctor of Tourism Faculty of Sciences ☐ Doctor of Sciences ☐ Doctor of Sciences: Biology ☐ Doctor of Sciences: Chemistry ☐ Doctor of Sciences: Physics ☐ Doctor of Sciences: Information Technology (tUL*) ☐ Doctor of Sciences: Statistics ☐ Doctor of Sciences: Mathematics ☐ Doctor of Sciences: Materiomics ☐ Doctor of Tourism School of Educational Studies ☐ Doctor of Educational Sciences (tUL*) ☐ Doctor of Tourism School of Social Sciences ☐ Doctor of Social Sciences ☐ Doctor of Tourism School of Transportation Sciences ☐ Doctor of Transportation Sciences ☐ Doctor of Tourism
Should one of the following logos be added? If applicable, ONLY the logo of an UHasselt research institute or center will be included on the bottem left of the first page (which otherwise is an exact copy of the cover). Deviations on this will not be allowed.	☐ No ☐ Yes: UHasselt research institute or center: ☐ BIOMED ☐ CMK ☐ DSI ☐ EDM ☐ IMOB ☐ IMO-IMOMEC ☐ LCRC
Logo of other institution(s) involved? If applicable, the logo of another involved institution will be included on the second page (back of the front page). Deviations on this will not be allowed.	☐ No ☐ Yes: Other institution(s) involved: (Please annex the logo to this form in format: .jpeg, .eps or .ai) ☐ Funding company: ☐ Strategic research center (VITO, IMEC, VIB, iMinds): ☐ Hospital: ☐ Public fund: ☐ Other: ☐ (Only for PhDs of BEW: mandatory inclusion of ‘AACSB Accreditation’ logo)
INVITATIONS/ANNOUNCEMENTS
Subsequent reception:	☐ No ☐ Yes If ‘Yes’ ask for notification of presence: ☐ No ☐ Yes If ‘Yes’, through which channel: ☐ Tel: ☐ Mobile: ☐ E-mail:
Invitations * Orders only possible in specified fixed edition.	☐ Digital ☐ Dutch ☐ English ☐ Printed*: ☐ Dutch: ☐ x6 ☐ x12 ☐ x36 ☐ x50 ☐ x100 ☐ English: ☐ x6 ☐ x12 ☐ x36 ☐ x50 ☐ x100
Announcement	After the approval of the PhD student and the UHasselt promoter, the Communication and Marketing office will send the digital version of the announcement to all faculties/schools.
INVOICE DETAILS
Invoice details * If unknown, please contact your coordination financial cell or the Administrative director of the faculty/school.	Financial cell of your faculty/school: Financial UHasselt account/Order form number*: Further specification:

Available on Intranet/Communication and events/Communicatie/Communicatietips

The logo can be requested from the faculty (rachel.moreau@uhasselt.be or cindy.vankerkom@uhasselt.be)