STUDENT APPLICATION FORM (Dossier d Inscription) ACADEMIC YEAR (Année Scolaire )

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1 Institut d Administration des Entreprises SOCRATES/ERASMUS APPLICATION DEADLINE : 20th November 2010 OTHER (Autre) STUDENT APPLICATION FORM (Dossier d Inscription) ACADEMIC YEAR (Année Scolaire ) Fall Semester Spring Semester Year (Semestre 1 : Sept.10 Jan.2011) (Semestre 2 : Jan.2011-Mai 2011) (Année : Sept.2010-Mai 2011) FIELD OF STUDY: (Domaine d Etude) STUDENT S PERSONAL DATA (to be completed by the student) Informations personnelles (à remplir par l étudiant) Family name: (Nom de famille) First name:... (Prénom) Sex: M F (Sexe) Date of birth (dd/mm/yy):. / /.... Date de naissance (jj/mm/aa): Nationality:..... (Nationalité) Place of birth:... (Lieu de naissance) Permanent address (Adresse permanente): Phone (landline): Cell phone:..... (tél. domicile) (tél. mobile) (Courriel) SENDING INSTITUTION:.. (Université d origine) Name and full address:.... (Nom et adresse complète) Departmental coordinator:... (Coordinateur de département) Ph.:.. Fax.:. (Courriel)

2 ACADEMIC BACKGROUND (Formations précédentes) Degrees /Diplomas Diplômes obtenus Grades Notes Dates University/College record Etablissements (titres, lieu) Language qualifications are especially important for these courses, so please give full details below: (Le niveau en langue est très important pour ces cours, veuillez détailler précisément ci-dessous) 2 nd language (other than native) (Deuxième langue autre que maternelle) The pre-requisite for this program is a level certified as per the CERL (Cadre Européen de Référence des Langues) B2 in French B1-B2 in English B1-B2 in Spanish Please provide a copy of a FLE (French as a Foreign Language) certification or a letter of recommendation from your language teacher. Do you wish to attend FLE courses? Yes No (Voulez- vous assister à des cours de FLE /Français Langue Etrangère?) (Oui) (Non) PROGRAM CHOICE: (Choix du programme) ENSEIGNEMENTS DIVERS (***ED): (Programme enseignements divers ouvert aux étudiants d échange) LICENCE: MASTER: DUGCI* : Mix & Match program in which exchange students are entitled to pick some subjects from our programs below (Licence/Master/Dugci). The picklist with the courses open to exchange students is available on the Internet, refer to it or talk to your coordinator NB: STUDENTS WILL BE REGISTERED IN THE SUBJECTS OPEN TO THEM WITHIN THE DUGCI PROGRAM ON A FIRST COME FIRST SERVE BASIS. Courses taught in French (en français) Courses taught in French (en français) Courses taught in English (en anglais) * DIPLOME D UNIVERSITE DE GESTION COMMERCIALE INTERNATIONALE (The DUGCI is a full-year program with a registration fee. It is entirely taught in English. It is open to international students not registered within an exchange program. Exchange students (Erasmus or other) will only be entitled to a selection of courses from the DUGCI package The list of courses (***ED) open to exchange students is available on the Internet)

3 Please write a short paragraph about the reasons why you want to join this program: (Veuillez écrire un paragraphe sur les raisons pour lesquelles vous voulez vous inscrire dans ce programme)

4 LEARNING AGREEMENT (Contrat d études) Academic year: (Année Scolaire: ) One copy of this form must be completed with a full list of courses for the semester and returned to the International Relations Office (Une copie de ce formulaire doit être remplie avec une liste complète des cours pour le semestre et renvoyée au Bureau des Relations Internationales) Student s name:.. (Nom de l étudiant) Sending University:.... (Université d origine) Duration (Durée):.. Degree Code (Code diplôme) Code for Exchange Students (Code pour les étudiants du programme d échange) Course title (Titre des cours) Number of credits (Nombre de crédits) TOTAL ECTS Student s signature: (Signature de l étudiant) Date: / / Home Institution: we confirm that this learning agreement has been approved (Université d origine: nous confirmons que ce présent contrat d études a été accepté) Name and Signature of the Departmental Coordinator:.. (Nom et Signature du Coordinateur de Département) Host Institution: we confirm that this learning agreement has been approved (Université d accueil: nous confirmons que ce présent contrat d études a été accepté) Name and Signature of the Departmental Coordinator:.. (Nom et Signature du Coordinateur de Département)

5 Institut d Administration des Entreprises Changes Form in the Learning Agreement (Les modifications des cours) Academic year: Student s name:.. Sending University:.... Duration: Degree Code Code for Exchange Students Course title Deleted (Supprimé) Added (Ajouté) Number of credits TOTAL ECTS Student s signature: Home Institution : we confirm that this learning agreement has been approved Name and Signature of the Departmental Coordinator:... Host Institution : we confirm that this learning agreement has been approved Name and Signature of the Departmental Coordinator:...

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