Worldwide Alliance programme
Application form 2015
May 11th September 11th, 2015
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School: ..
Nom / Surname : .....
Prnom / First name : ...
Homme / Male Femme / Female
Date de naissance / Date of birth : ...........
Nationalit / Nationality :........
Adresse / Address...
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Code postal / Zip code : Ville / City : ....................................................
Pays / Country: ...
Tlphone / Telephone : Portable / Mobile..
E-mail : ...
Vos contacts lInstitut Paul Bocuse Your contacts at the Institut Paul Bocuse:
Sophie Reynaud, Alliance program Coordinator: [email protected] - 00.33.(0)4.72.18.09.86
Elonore Vial, Dean and the Alliance Program Director: [email protected] -
Chteau du Vivier 69130 Ecully cedex France - Tel: 33/472 18 02 20 - www.institutpaulbocuse.com
Situation scolaire /School attended
Diplme prpar / Degree- Diploma in preparation & Anne ou semestre actuellement suivi Year or semester currently attending
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Autres diplmes / Other degree-diploma
Anne-YearDiplme-diploma resultEtablissement School
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Langues vivantes / Language skills
* abrviations indiquer dans les colonnes/*abbreviations to use in the columns :
F : courant- Fluent I:Intermediate SL : Niveau scolaire- school level (SL + ou SL-) B: dbutant Beginner
Langue maternelle
Mother tongue
Expression crite*
Written language
Expression orale*
Spoken language
Franais French
Anglais English
Espagnol Spanish
Autres Others
Exprimez en quelques mots, votre motivation pour ce programme lInstitut Paul Bocuse en franais Express in a few word, your interest and motivation for this culinary program at Institut Paul Bocuse in French
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PAIEMENT de LINSCRIPTION: au plus tard le 10 Mars 2015
TUITON 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 soussign(e) (nom-prnom) / I the undersign (first name last name)
Ecole Membre / School Member:
Rgle mon inscription / Pay the tuition fees:
Par carte bancaire / by credit card
Visa MasterCard / Eurocard
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Expirant le / expiration date /../..
Date de prlvement / charging date: /../..
Jautorise lInstitut Paul Bocuse dbiter 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 - 09
Numro de compte bancaire international IBAN
FR 76 3000 4014 2800 0100 2480 909 Institut Paul Bocuse Htellerie et Arts Culinaires
Code dIdentification bancaire - BIC / BNPAFRPPLPD
Merci de prciser le nom & prnom du canditat sur le virement thanks to specify the candidate full name on the bank transfe.
Date & Signature:
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 tudiant). 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 Responsabilit 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 Insurance
Multi-risk insurance is compulsory for staying in the student housing.
Securit 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.
Pices joindre obligatoirement au dossier de candidature /The following documents must be enclosed with the application form:
Le dossier dinscription complt & sign the Application form filled & signed
Votre CV en franais / 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 mdical daptitude au mtier la cuisine / Medical cerificate to garanty you are apt to work in kitchen
Le document PAIEMENT de LINSCRIPTION dment compt et sign / The document TUITON FEES PAYMENTcompleted and signed
Je certifie avoir pris connaissance des conditions gnrales du programme (contenu et rglement intrieur de lInstitut Paul Bocuse) et les accepte telles quelles sont prsentes. /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 ltudiant / Candidate's signature :
FAVOR DE LLENAR A COMPUTADORA. NO SE RECIBIRN MANUSCRITOS/ HAND WRITTEN APLICATIONS WILL NOT BE ACCEPTED
FAVOR DE LLENAR A COMPUTADORA. NO SE RECIBIRN MANUSCRITOS/ HAND WRITTEN APLICATIONS WILL NOT BE ACCEPTED
