APPLICATION FORM EXCHANGE PROGRAMS

Transcription

1 ISARA-Lyon 23 rue Jean Baldassini Lyon cedex 07 International Relations Office: Sigolène VERNERET +33 (0) sverneret@isara.fr APPLICATION FORM EXCHANGE PROGRAMS ACADEMIC YEAR : 2015/2016 This form must be completely typed, signed, scanned and sent by Application deadlines Arrival date Last name: Departure date: Fall Semester: between April 15 th and June 1 st Spring Semester: between September 1 st and October 15 th Year: between April 15 th and June 1 st Date of birth (D, M, Y): Place of birth (City and country): First name (s): Gender: Female Male Nationality: Mother tongue: Permanent address: Street & number: City: Zip code: Country: Tel: Person and telephone number in home country to contact in case of emergency: Name: Tel: Home University: Complete address (Street, number, zip code, city, country): Name of the exchange coordinator of your university: Telephone number: Knowledge of languages according to the Common European Framework of References French: Understanding C2 C1 B2 B1 A2 Speaking C2 C1 B2 B1 A2 Writing C2 C1 B2 B1 A2 English: Understanding C2 C1 B2 B1 A2 Speaking C2 C1 B2 B1 A2 Writing C2 C1 B2 B1 A2 Others: Please precise Understanding C2 C1 B2 B1 A2 Speaking C2 C1 B2 B1 A2 Writing C2 C1 B2 B1 A2 Please add to this application form a copy of all your official tests Type of Exchange Programme ERASMUS Bilateral institutional exchange Other (please specify): ISARA-Lyon Application form

2 LEARNING AGREEMENT Student s name: Please consult the International Student Guide on our website Admission will not be granted unless this section is fully completed Home institution: Country: Specialization of study chosen: CHOOSE Number of ECTS credits to be obtained at ISARA-Lyon: Current level of studies: Bachelor 1 st year 2 nd year 3 rd year 4 th year Master 1 Master 2 Tick the equivalence if your are in an engineer curriculum Diploma/degree expected: Bachelor Master Engineer Date : INTENDED STUDY PROGRAM Code (indicated on ECTS Guide) COURSE UNIT DURATION Title Start End NUMBER OF CREDITS TOTAL (if necessary, continue this list on a separate sheet) RESEARCH if necessary (Subject to approval) Field Laboratory Further remarks for the study plan I agree to take all exams related to the course I hereby approve the above plan of study/learning agreement: Student s signature: Sending Institution - Coordinator s signature: Name, signature and stamp of the institution Date: Date: I hereby approve the above plan of study/learning agreement: Receiving Institution International Relations: Sigolène Verneret Education Department: Alain Gay or Séverine Stéphany Date: ISARA-Lyon Guide ECTS

3 LETTER OF INTEREST To be written in French if you plan to attend most of your scientific classes in French. To be written in English if you plan to attend most of your scientific classes in English. Please indicate in this letter (maximum one page): - The reasons for applying at ISARA-Lyon, - The reasons for applying to a particular specialization of study - If you want to do an internship, indicate in which structure and what kind of internship you are looking for, why, and your experience in this related field. ISARA-Lyon Guide ECTS

4 ACCOMODATION APPLICATION FORM Accommodation will be given on a first come first serve basis and according to ISARA s possibility. Remember that once ISARA-Lyon gives you a confirmation about the housing you chose, you are committed for the whole period of your stay. Please refer to the International Student Guide on our website for detailed information. Last name: First name: Person to contact in case of emergency: Name: Telephone: Period: Fall semester: August / September to December Spring semester: January to June / July Please rank housing proposition according to your preference: 1 = favourite 7 = least favourite For more details on the different choices (price, location, ), please check the Course Guide for International Students on our website. ALLIX Crous Residence Room ISARA-Lyon can book it for you ALLIX Crous Residence Studio DELESSERT Crous Residence Room La MADELEINE Crous Residence Room ISARA-Lyon might have some possibilities Family I prefer looking for my own place to live Lyon Expat families Private Residence Flat to share I agree to pay all deposit, file, reservation and insurance fees requested. I also agree to fully comply with all regulations concerning accommodation. Signature and date: ISARA-Lyon Guide ECTS

5 CERTIFICATE OF KNOWLEDGE OF THE FRENCH LANGUAGE To attend scientific courses in French a B1 Level according to the Common European Framework of Reference for Languages, is required. Designated University Official of the home institution: Function: address: Phone number: Home University: Country: Hereby certifies that the student (first name and last name): under the: (Name of the programme) Student Exchange Program from (School / Faculty / Department) has reached the required level of French so as to follow lectures and take examinations during his/her study period at ISARA-Lyon, France. Other remarks: Please add any other document proving the level. Place & Date: Signature & stamp of the Institution: ISARA-Lyon Guide ECTS

6 CERTIFICATE OF KNOWLEDGE OF THE ENGLISH LANGUAGE Please fill in this form if you want to attend courses in English. To attend scientific courses in English a B1 Level according to the Common European Framework of Reference for Languages, is required. Designated University Official of the home institution: Function: address: Phone number: Home University: Country: Hereby certifies that the student (first name and last name): under the: (Name of the programme) Student Exchange Program from (School / Faculty / Department) has reached the required level of English so as to follow lectures and take examinations during his/her study period at ISARA-Lyon, France. Other remarks: Please add any other document proving the level. Place & Date: Signature & stamp of the Institution: ISARA-Lyon Guide ECTS

7 INSURANCE COVERAGE Please refer to the International Student Guide on our website for detailed information on insurance. For non-european: Please tick one of the two propositions below: * I attest that I will subside to the mandatory French Students Health Care Insurance (213 price for ) * Concerning complementary insurance, I certify that I have my own insurance covering: - Medical costs & hospitalisation yes no - Civil liability yes no - Repatriation yes no - Work accidents yes no - Other: I attached to my application a copy of my contract valid for your whole period in France. (Cf. example p.9) * I attest that I will subside to the mandatory French Students Health Care Insurance (213 price for ) * Concerning complementary insurance, I prefer to subside to a French one once I ll be in Lyon. To be signed once in Lyon: I the undersigned, (name and surname) attest that I received all necessary information about complementary insurance and I m responsible to subside to any complementary insurance recommended by ISARA-Lyon. ISARA-Lyon Guide ECTS

8 For European * I attest that I will bring my European Health Insurance Card with the appropriate expiry date. If I m not able to bring my European Health Insurance Card, I attest that I ll subscribe to the mandatory French Students Health Care Insurance. (213 price for ) Please tick one of the two propositions below: * Concerning complementary insurance, I certify that I have my own insurance covering: - Medical costs & hospitalisation yes no - Civil liability yes no - Repatriation yes no - Work accidents yes no - Other: I attached to my application a copy of my contract valid for your whole period in France. (Cf. example p.9) * Concerning complementary insurance, I prefer to subside to a French one once I ll be in Lyon. To be signed once in Lyon: I the undersigned, (name and surname) attest that I received all necessary information about complementary insurance and I m responsible to subside to any complementary insurance recommended by ISARA-Lyon. ISARA-Lyon Guide ECTS

9 EXAMPLE OF PROOF OF INSURANCE COVERAGE (to be completed by the insurance company) We (Name and address) hereby certify that Mr / Miss / Mrs: (Last name) (First name) has been provided with the adequate compulsory insurance coverage for: - Medical costs & hospitalisation yes no - Civil liability yes no - Repatriation yes no - Work accidents yes no - Other: during his/her study period at ISARA-Lyon France From to (day / month / year). (Please join a copy of the procedure to be followed, should arise the need) Place & Date: Signature & stamp: Your own private insurance won t prevent you from having to subscribe to the French students health care if you are not a EU-citizen or a EU-citizen without a European Health Care Card. For more information please consult the International Student Guide on our website ISARA-Lyon Guide ECTS

10 CHECK LIST Your application is complete once you have filled out this application form and added all required documents, please check: First page application information Learning agreement Letter of interest (in French if most of courses you will attend are in French Accommodation application form Certificate of knowledge of French language + English language Official Language tests Insurance coverage Additional documents required: A copy of your passport A copy of your birth certificate Your curriculum vitae (in French if most of courses you will attend are in French) A copy of your Bachelor Diploma Grades for the last 3 years 1 scanned passport picture in.jpeg format I attest that all documents are valid Date and Signature ISARA-Lyon Guide ECTS