explications formulaire LS - Consulate General of France in Chicago

HOW TO FILL OUT THE LONG STAY APPLICATION FORM
1
2
3
4
5
6
7
8
Nom(s)
Nom(s) de famille antérieur(s)
Prénom(s)
Date de naissance
Lieu de naissance
Nationalité actuelle
Nationalité à la naissance…
Sexe
9
Etat civil :
- célibataire
- marié(e)
- séparé(e)
- veuf(ve)
- autre
10 Pour les mineurs…
11 Numéro national d’identité…
12 Type du document de voyage :
13
14
15
16
17
18
19
20
- passeport diplomatique
- passeport officiel
- passeport de service
- passeport spécial
- autre document de voyage (à
préciser)
Numéro du document de
voyage
Date de délivrance
Date d’expiration
Délivré par
Adresse du domicile
Adresse électronique
Numéro(s) de téléphone
En cas de résidence…
21 Activité professionnelle…
22 Employeur
23 Je sollicite…
- activité professionnelle
- études
- stage/formation
- mariage
Last name(s) (like it appears in your passport)
Former last name if you have one
First name(s)
Date of birth (d/m/y)
Place of birth
Current citizenship
If different, citizenship at birth
Check the appropriate box (« masculin » for male,
« féminin » for female)
Check the appropriate box:
- single
- married
- separated,
- widow(er)
- other
If you’re under 18, write down the last name, first
name, home address and citizenship of your legal
guardian.
Leave this box blank
Check the appropriate box concerning your travel
document:
- diplomatic passport
- official passport
- service passport
- special passport
- other (explain)
Travel document number
Date of issue of your travel document (d/m/y)
Date of expiry of your travel document (d/m/y)
Authority who issued your travel document
Home address
Email address
Phone number
If you’re not a US citizen, write down the number of
your residency permit, its date of issue and its date of
expiry
Current profession
Name, address, email address and phone number of
your employer or your school/university
Purpose of your stay in France
- work
- studies
- internship/training
- wedding
- raison médicale
- établissement familial
- établissement privé/visiteur
- visa de retour
- prise de fonctions officielles
- autre
24 Nom, adresse…
25 Quelle sera votre adresse… ?
26 Date d’entrée prévue…
27 Durée prévue du séjour…
28 Si vous comptez…
- lien de parenté
- nom(s), prénom(s)
- date de naissance
- nationalité
29 Quels seront vos moyens… ?
Serez-vous titulaire d’une
bourse ?
30 Serez-vous pris(e) en
charge… ?
31 Des membres de votre
famille… ?
32 Avez-vous déjà résidé… ?
Si oui…
A quelle(s) adresse(s) ?
Lieu et date
Signature
- medical reason
- familial establishment
- private establishment/visitor
- visa to go back to France – for holders of a valid
« récépissé de demande de renouvellement de carte de
séjour »
- if you are going to work for an Embassy, Consulate,
international organizations…
- other
Name, address, email address, phone number in France
of your employer / host organization / host family
member…
Address in France during your stay
Date on which you plan to enter France (d/m/y)
Number of weeks/months/years you plan on staying in
France
If you plan on going to France with family members,
write down:
- relationship
- last name(s), first name(s)
- date of birth (d/m/y)
- citizenship
How will you cover your expenses in France?
Are you a scholarship recipient? Check the appropriate
box – « oui » = yes, « non » = no ; if you are, write
down the name, address, email address, phone number
of the organism, and the amount of the scholarship.
Will someone in France cover for your expenses? If so,
write down their name(s), citizenship, how they are
related to you, their address, email address and phone
number.
Do you have family members living in France? If so,
write down their name(s), citizenship, how they are
related to you, their address, email address and phone
number.
Have you already stayed in France for more than 3
months?
If so, please write down the dates and purpose of your
stay.
Write down the address(es) where you were living
Write down the place and date where and when you fill
this form
Please sign ; if you are under 18, your legal guardian
must sign for you