First name *
Last name *
E-mail *
Are you a student at Lerkeveld or an external? *
1st choice *
2nd choice *
3rd choice *
Please leave your comments here. For example, what date do you choose (if applicable)? Would you like to participate in more than 1 module? Are any of your choices of interest to your studies? Why specifically do you want to do that module? All comments are welcome.