Worldwide Alliance programme Application form 2014 May 12th September 12th, 2014

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1 Worldwide Alliance programme Application form 2014 May 12th September 12th, 2014 School:.. Photo Nom / Surname :..... Prénom / First name :... Homme / Male Femme / Female Date de naissance / Date of birth : Nationalité / Nationality :... Adresse / Address.... Code postal / Zip code : Ville / City :... Pays / Country:... Téléphone / Telephone : Portable / Mobile Vos contacts à l Institut Paul Bocuse Your contacts at the Institut Paul Bocuse : Sophie Reynaud, Alliance program Coordinator: sophie.reynaud@institutpaulbocuse.com (0) Eléonore Vial, Dean and the Alliance Program Director: eleonore.vial@institutpaulbocuse.com Château du Vivier Ecully cedex France Tel : 33/

2 Situation scolaire /School attended Diplôme préparé / Degree Diploma in preparation : Année ou semestre actuellement suivi Year or semester currently attending... Autres diplômes / Other degreediploma AnnéeYear Diplômediploma result Etablissement School Langues vivantes / Language skills * abréviations à indiquer dans les colonnes/*abbreviations to use in the columns : F : courant Fluent I :Intermediate SL : Niveau scolaire school level (SL + ou SL) B : débutant Beginner Langue maternelle Mother tongue Expression écrite* Written language Expression orale* Spoken language Français French Anglais English Espagnol Spanish Autres Others Exprimez en quelques mots, votre motivation pour ce programme à l Institut Paul Bocuse en français Express in a few word, your interest and motivation for this culinary program at Institut Paul Bocuse in french

3 ASSURANCES incluses INSURANCES included in the Fee Assurance Responsabilité civile Third party Insurance: Insurance covering all accidents and injuries caused to a third party during your stay is mandatory. Assurance Habitation MultiRisk Housing Insurance Multirisk insurance is compulsory for staying in the student housing. Securité Sociale student's Social Security The student's Social Security is mandatory for all students in higher education less than 28 years. The annual fee is 207 Euro. The national insurance will reimburse a part of your medical expenses. We recommend strongly that you take private international insurance in order to cover complementary medical needs, all accidents and injuries, repatriation... This is not included in the fee Private international insurance Students over 28 : The student's Social Security system stops at 28 years. You must have a private international insurance covering medical needs, all accidents and injuries caused to them or by them during their stay at the Institut Paul Bocuse. A proof of this insurance must be provided with the application form.. This Insurance covers all accident and injuries caused to yourself (falls cuts and burns) during your stay. This policy must cover your medical costs, hospitalization, and eventual repatriation. You must provide proof of this insurance prior to the start of the course. This is not included in the fee. VISA : Warning : you will get your invitation letter for the embassy only once the fee paid. You have to count a minimum of 2 full months of delay for obtaining your visa. Once in Lyon you will have to get a student Visa (Visa étudiant long séjour ). We will help you in the procedures and will provide 2 fiscal stamps of a value of 59 Euros (included in the fee).

4 PAIEMENT de L INSCRIPTION : au plus tard le 12 Mars 2014 TUITON FEES PAYMENT : the latest March 12 th, 2014 You will receive your invitation letter for the visa only once the fee paid A retourner / please, send: sophie.reynaud@institutpaulbocuse.com Je soussigné(e) (nomprénom) / I the undersign (first name last name) Ecole Membre / School Member : Règle mon inscription / Pay the tuition fees : Par carte bancaire / by credit card Visa MasterCard / Eurocard n Expirant le / expiration date /../.. Date de prélèvement / charging date : /../.. J autorise l Institut Paul Bocuse à débiter la somme de (Cinq mille cinq cent cinquante uros) / I authorize the Institut Paul Bocuse to charge my credit card for an amount of (five thousand five hundred and fifty uros) Par virement bancaire / by bank transfer Merci de préciser le nom & prénom du canditat sur le virement thanks to specify your full name on the bak transfer Banque BNP PARIBAS : BNPPARB LYON AG CENTRALE (02249) Code Numéro de compte bancaire international IBAN FR Institut Paul Bocuse Hôtellerie et Arts Culinaires Code d Identification bancaire BIC / BNPAFRPPLPD Date & Signature :

5 Pièces à joindre obligatoirement au dossier de candidature The following documents must be enclosed with the application form: Votre CV en français / your CV in French Copie de votre passeport / Copy of your passport Le justificatif de votre assurance médicale internationale / Certificate stating legal, international social & medical Insurance Un Certificat médical d aptitude au métier la cuisine / Medical cerificate to garanty you are apt to work in kitchen Le document «Paiement de l inscription» dument rempli /Tuition fee paiement document filled Je certifie avoir pris connaissance des conditions générales du programme (contenu et règlement intérieur de l Institut Paul Bocuse) et les accepte telles qu elles sont présentées. I herewith confirm that I have read the general conditions of the program (contents and rules of the Institut Paul Bocuse) and that I agree with them. Lieu & date / Place and date : Signature de l étudiant / Candidate's signature : Vos contacts à l Institut Paul Bocuse Your contacts at the Institut Paul Bocuse : Sophie Reynaud, Alliance program Coordinator: sophie.reynaud@institutpaulbocuse.com (0) Eléonore Vial, Dean and the Alliance Program Director: eleonore.vial@institutpaulbocuse.com Château du Vivier Ecully cedex France Tel : 33/