Request Financial Support and/or Certificate for Board Membership Activities

If you are entitled to financial support you will automatically receive a certificate. If you are not entitled to financial support, you can still request a certificate attesting to your effortsby filling in this form.
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Have you received an award letter from your board stating how many months' worth of financial support you are entitled to, or have you been included in the overview drawn up by your faculty assessor? *

Yes

You can continue completing this form

If you are entitled to financial support: await your award letter before submitting this form. For further information, see financial support for student board members, section on 'Division of funds'.
If you are not entitled to financial support and will therefore not receive an award letter: you can still complete this form to request a certificate attesting to your board membership activities.

Indicate the type of board activities *

Which board were you a member of? *

Which study association were you a member of? *

Which co-participation body were you a member of? *

For which student association were you a board member? *

For which sports association were you a board member? *

For which job fair organisation were you a board member? *

For which student party were you a board member? *

For which lustrum committee were you a board member? *

Other *

Are you making use of the tuition fee-free board membership ruling (regeling collegegeldvrij bestuur)? *

Yes

Have you already received financial compensation for board membership duties? *

I have never received financial compensation for board membership

I have previously received financial compensation for board membership

How many months' worth? *

During your entire period of registration as a student of Leiden University you are entitled to a maximum of 18 months' worth of financial compensation. See financial support for student board members.

Your period of board membership started on *

Up to and including *

How many recognised months of board membership activities have you undertaken? *

During your period of board membership, were you entitled to a top-up grant from DUO? *

Yes

How long were you entitled to it? *

The whole period

Part of the period

Namely from *

Up to and including *

Personal details

Initials of first name(s) *

First names (as stated in your passport) *

Surname *

Student number *

Email address *

Date of birth *

Name bank account holder *

Country *

Netherlands

Abroad

Which country *

Street *

House number *

Postcode *

Town/city *

IBAN *

Account number *

Attachments

Chairperson's statement

Signed chairperson's statement from the association, organisation or committee / Statement from the faculty assessor / Statement from the faculty-university management organisation *

Tuition fee-free board membership

Agreement between the student and Leiden University concerning tuition fee-free board membership in the academic year 2019-2020 *

Student registration at Leiden University
Proof of student registration at Leiden University for the year in which you carried out the board membership activities (from uSis).
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Proof of student registration at Leiden University *

Top-up grant from DUO

If you were entitled to a top-up grant during your period of board membership, upload a copy of your DUO financial overview (example).

DUO financial overview *

* = Input is required