Worldwide Alliance program Application form 2016 May 2nd

Worldwide Alliance program
Application form 2016
May 2nd – August 5th 2016
School:
Photo
Nom / Surname:
Prénom / First name:
Homme / Male

Femme / Female

Date de naissance / Date of birth :
Nationalité / Nationality :
Adresse / Address
Code postal / Zip code : ………………
Ville / City:
Pays / Country:
Téléphone/Telephone:
Portable / Mobile:
E-mail:
Heure d’arrivée /Time of arrival: Friday 29th of April, 2015 at:
Jour de départ / check out date: 6th of August 2015
Vos contacts à l ’Institut Paul Bocuse Your contacts at the Institut Paul Bocuse:
Sophie Reynaud, International Cooperation Manager: [email protected]
00.33.(0)4.72.18.09.86
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
Expression écrite*
Expression orale*
Mother tongue
Written language
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 words your interest and motivation for this culinary program at Institut Paul
Bocuse in French
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 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.
 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 Insurance
Housing multi-risk insurance is compulsory for staying in the student residence.
 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.
 ASSURANCE PRIVEE INTERNATIONALE non Incluse /PRIVATE INTERNATION INSURANCE Not
included in the Fee
You must have a private international insurance covering medical needs in complementary of
the French national insurance, 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 p3
 Copie de votre visa à joindre ultérieurement/ visa copy to send later
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 :
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PAIEMENT de L’INSCRIPTION : au plus tard le 20 Février 2016
TUITON FEES PAYMENT : the latest February 20th, 2016
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
Merci de préciser le nom & prénom du canditat sur le virement – Thanks to specify the candidate full
name on the bank transfer.
Banque BNP PARIBAS : BNPPARB LYON AG CENTRALE (02249)
Code 30004 – 01428 - 00010024809 - 09
Numéro 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
Date & Signature :
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