french institute

alliance française

Registration Form

DELF All Audiences and DALF – Session q Juin q Décembre

Candidate’s Code (if you have previously taken the DELF/DALF) : ______- ______

Please write clearly to avoid errors on your certificate-Thank you

Information (as it appears on your passport or birth certificate)

Title qMr. qMrs . qMs.

First Name: ______Last Name: ______

Date of Birth: ______(e.g: November 11, 1999)

Place of Birth - City: ______State: (write out) ______

Country of Birth: ______Nationality(ies): ______

Native tongue: ______(one only)

Present Address: ______Zip Code: ______City: ______State/Country: (write out) ______

qHome Phone or qCell Phone: ______qWork Phone: ______

Email Address: ______

Professional Status: qBusiness qCommerce qFull-time Employee qFreelance qTeacher qStudent qUnemployed qOther

Exam(s) to take

Exam Level(s) qA1 qA2 qB1 qB2

qC1 Humanities & Social Studies qC1 Sciences

qC2 Humanities & Social Studies qC2 Sciences

Note: If you choose more than one level, make sure the dates do not overlap.

Reason(s) for taking the exam, check all that apply?

q For immigration to Canada or Quebec (at least take the DELF B1)

q For admission to French Universities (at least take the DELF B2)

q For Teaching Assistant Program in France (TAPIF) (at least take the DELF B1)

q For certification of my French-language skills for personal reasons

Payment

qI will pay with qAmex qMC qVisa # ______

Expiration Date : _ _ / _ _

qI will pay with Check/Money Order to FIAF Amount: ______

qI understand that the exam fee is non-refundable. Signature ______

Special request (impaired vision or hearing – incapacity to write due to injury - others)

Please email a medical note to Ms. Voahangy Siraisi –

Registration procedure/Ways to register

1. Fill out and email your registration form to

2. Pay by check/money order to FIAF by mailing it to Voahangy Siraisi (re: DELF) at FIAF, 22 East 60th Street – New York, NY 10022.

Your registration is confirmed once the payment of your exam fee is processed.

You will receive a notification with time, room numbers, and important information concerning your exam after the registration deadline has passed.

Merci et à bientôt!

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