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APPLICATION FORM FOR ADMISSION EXCHANGE PROGRAM

(3 photographs)

ACADEMIC YEAR 2012-2013

Groupe ISA 48 Boulevard Vauban 59046 LILLE cedex - FRANCE Head of International Programs Office: Ms Florence MALAISE  +33 (0)3 28 38 46 10  +33 (0)3 28 38 48 47 email : f.malaise@isa-lille.fr This form must be filled in completely. Type or write very clearly (in black ink). � Semester 1 (Fall)

Application deadline : May 1st

� Semester 2 (Spring)

Application deadline : November 1st

� Semesters 1 & 2 (one academic year)

Application deadline : May 1st

� Double degree

Application deadline : May 1st

Expected arrival date: ……………………………………. Expected departure date: ……………………………….. Number of years of study prior to departure :

Date of birth (D,M,Y) :

Last name:

Place of birth:

First name:

Gender:

Female � Male �

Nationality:

Mother tongue:

Current address:

Current address is valid until :

:……………………………………………………………………………………………… City: ……………………………………………………………….… Postal code: ………………………...

Tel:

Fax:

E-Mail:

Home University: (Full name)

Socrates code for European Universities:

Contact person at home University: (name, address, tel, fax, e.mail) Language skills: French :

Excellent � Excellent �

Advanced � Advanced �

Intermediate � Intermediate �

(oral) (written)

English :

Excellent � Excellent �

Advanced � Advanced �

Intermediate � Intermediate �

(oral) (written)

Other : Excellent � …………………. Excellent � Type of Exchange Programme:

Advanced � Advanced �

Intermediate � Intermediate �

(oral) (written)

� ERASMUS � Other (please specify): .......................................................................... ..............

� Bilateral institutional agreement


ISA_exchange_student_application_form_2012-2013  

http://nubip.edu.ua/sites/default/files/ISA_exchange_student_application_form_2012-2013.doc

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