APPLICATION FORM FOR EXCHANGE STUDENTS

Academic year 2015-2016

Please fill your application form using a computer

SENDING UNIVERSITY
Name of the university:
Address:
Faculty/department:
Departmental coordinator:
Tel:
Fax:
E-mail:
Institutional coordinator:
Tel:
Fax:
E-mail:
STUDENT PERSONAL DATA
First name(s) as on passport :
Family name as on passport:
Date and place of birth:
Nationality:
Sex: ChooseFM
Address:
Tel:
E-mail:
Tel:
E-mail:
PROPOSED ENROLMENT
Are you applying for one or two semesters (Please tick)
one semester two semesters
Starting in
HEI autumn semester (September-January) HEI spring semester (February-July)
Others: (please give dates)
From: To:
LANGUAGE COMPETENCE
First language:
Language of instruction at home institution (if different):
Other languages / I am currently studying this language / I have a sufficient level to follow lectures / I would have a sufficient level to follow lectures if I had extra preparation
Yes / No / Yes / No / Yes / No
PREVIOUS AND CURRENT STUDIES
What degree are you currently enrolled in?
Number of higher education study years prior to departure abroad:
Student’s signature
Date / Coordinator’s signature
Date
Please return to:
Hautes Etudes d’Ingénieur
International office
13 rue de Toul
59046 LILLE CEDEX FRANCE
and at
/ With following documents:
-  Copy of passport or ID
-  An official nomination letter (an e-mail from your coordinator is accepted),
-  Transcripts of records,
-  A covering typed letter stating reasons for application,
-  Proof of proficiency in French (reference letter from professor, diploma, - B2 Certificate or equivalent…), Intermediate and advanced level classes in French language are provided for exchange students.
-  Learning agreement (approved by your university).

Application form 2015/2016

Deadline for application:

For autumn semester 2015 and the whole academic year: 15/05/2015

For spring semester 2016: 15/10/2015

HOST INSTITUTION
We hereby acknowledge receipt of the application, the proposed learning agreement and the candidate’s transcript of records. The above-mentioned student is
provisionally accepted in our institution not accepted in our institution
Departmental coordinator’s signature
Date / Institutional coordinator’s signature
Date

Application form 2015/2016