€¦ · Web viewWorldwide Alliance programme. Application form 2015. May 11th – September...
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FAVOR DE LLENAR A COMPUTADORA. NO SE RECIBIRÁN MANUSCRITOS/ HAND WRITTEN APLICATIONS WILL NOT BE ACCEPTED Worldwide Alliance programme Application form 2015 May 11th – September 11th, 2015 School: ………………………………………..…………… Nom / Surname : ………………………………………..………………………..……. Prénom / First name : ………………………………………….…………………….. Homme / Male o Femme / Female o Date de naissance / Date of birth ........ ... : ……… ……………………………… ……………………… Nationalité / Nationality : ........………………………………………………………… ……………………… Adresse / Address………………………………………………………………..………………….………………… …………………………………………………………………………………………………………………………….…… Code postal / Zip code : ……………… Ville / City : .................................................... Pays / Country: ………………………………………………………………………………….…………………….. Photo
Transcript of €¦ · Web viewWorldwide Alliance programme. Application form 2015. May 11th – September...
FAVOR DE LLENAR A COMPUTADORA. NO SE RECIBIRÁN MANUSCRITOS/ HAND WRITTEN APLICATIONS WILL NOT BE ACCEPTED
Worldwide Alliance programmeApplication form 2015
May 11th – September 11th, 2015
School: ………………………………………..……………
Nom / Surname : ………………………………………..………………………..…….
Prénom / First name : ………………………………………….……………………..
Homme / Male o Femme / Female o
Date de naissance / Date of birth………………………........………...……………………………… :
Nationalité / Nationality : ………………………........…………………………………………………………
Adresse / Address………………………………………………………………..………………….…………………
…………………………………………………………………………………………………………………………….……
Code postal / Zip code : ……………… Ville / City : ....................................................
Pays / Country: ………………………………………………………………………………….……………………..
Téléphone / Telephone : …………………………………Portable / Mobile………………….…….…
E-mail : ………………………………………..…………………………………………………………………………….
Vos contacts à l’Institut Paul Bocuse Your contacts at the Institut Paul Bocuse :
Sophie Reynaud, Alliance program Coordinator: [email protected] - 00.33.(0)4.72.18.09.86
Eléonore Vial, Dean and the Alliance Program Director: [email protected] -
Château du Vivier – 69130 Ecully cedex – France - Tel : 33/472 18 02 20 - www.institutpaulbocuse.com
Photo
FAVOR DE LLENAR A COMPUTADORA. NO SE RECIBIRÁN MANUSCRITOS/ HAND WRITTEN APLICATIONS WILL NOT BE ACCEPTED
¨Situation scolaire /School attended
¨ Diplôme préparé / Degree- Diploma in preparation & Année ou semestre actuellement suivi – Year or semester currently attending ……………………………………………………………………………………………….………………………………….
…………………………………………………………………………………………………………………………………….
¨ Autres diplômes / Other degree-diploma
Année-Year Diplôme-diploma 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--------
FAVOR DE LLENAR A COMPUTADORA. NO SE RECIBIRÁN MANUSCRITOS/ HAND WRITTEN APLICATIONS WILL NOT BE ACCEPTED
PAIEMENT de L’INSCRIPTION : au plus tard le 10 Mars 2015TUITON FEES PAYMENT : the latest March 10th, 2015
We will deliver your invitation letter for the visa only once the fee paid
A retourner / please, send: [email protected]
Je soussigné(e) (nom-prénom) / 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 5.550.00 € (Cinq mille cinq cent cinquante €uros)I authorize the Institut Paul Bocuse to charge my credit card for an amount of 5.550.00 € (five thousand five hundred and fifty €uros)
Par virement bancaire / by bank transfer
Banque BNP PARIBAS : BNPPARB LYON AG CENTRALE (02249)Code 30004 – 01428 - 00010024809 - 09Numéro de compte bancaire international – IBAN FR 76 3000 4014 2800 0100 2480 909 – Institut Paul Bocuse Hôtellerie et Arts
Culinaires Code d’Identification bancaire - BIC / BNPAFRPPLPD
Merci de préciser le nom & prénom du canditat sur le virement – thanks to specify the candidate full name on the bank transfe.
Date & Signature :
FAVOR DE LLENAR A COMPUTADORA. NO SE RECIBIRÁN MANUSCRITOS/ HAND WRITTEN APLICATIONS WILL NOT BE ACCEPTED
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). We will help you in the
procedures and we will provide the fiscal stamps (included in the fee).
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 which is mandatory.
Assurance Habitation - Multi-Risk Housing InsuranceMulti-risk 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 national insurance will take in charge a part of your medical expenses, if you have any, once in France. We recommend strongly that you take private international insurance in order to cover complementary medical needs, all accidents and injuries, repatriation... This one is not included in the fee.
ASSURANCE PRIVEE INTERNATIONALE non Incluse /PRIVATE INTERNATION INSURANCE Not included in the Fee
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. 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 with your application form.This is not included in the fee.
Pièces à joindre obligatoirement au dossier de candidature /The following documents must be enclosed with the application form:
Le dossier d’inscription complété & signé – the Application form filled & signed Votre CV en français / your CV in French Copie de votre passeport / Copy of your passport Le justificatif de votre assurance internationale / Certificate stating legal, international
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 » dûment compété et signé / The
document « TUITON FEES PAYMENT » completed and signed
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 :
