Exemple fictif d`un formulaire maison en français

UNIVERSITE
LIBRE
DE
BRUXELLES,
UNIVERSITE
D'EUROPE
DEPARTEMENT ENSEIGNEMENT - Service de Mobilité Etudiante
[email protected]
EXCHANGE PROGRAMS – APPLICATION FORM 2016-2017
PROGRAMMES D’ECHANGES – FORMULAIRE DE CANDIDATURE 2016-2017
CREPUQ - BILATERAL AGREEMENTS / CREPUQ - CONVENTIONS BILATERALES
To be sent, by email, with the required scanned documents on 31 March 2016 the latest, exclusively in the field of
our existing agreements
Formulaire et annexes scannés, à envoyer par email, au plus tard pour le 31 mars 2016, exclusivement dans le cadre
de nos accords d’Echanges existants.
Jalé-Tranger
Voya
FAMILY NAME:………………………………………………………………………..GIVEN
NAME: ............................................................
Gender:
F
M
Birthday (DD/MM/YYYY): _06
_ / 01
_ _ / _1985
___
Canadienne
Montréal, Canada
Birthplace (city and country) …………………………
............................................... Nationality………………………………………
Permanent address (where we will be able to join you until your arrival):
40 075, du Tour du Monde Street, Sainte-Anne-de-la-Pérade Québec Z9Y 8X7
…………………………………………………………………………………………………………………………………………………………………………...
[email protected]
E-mail address: ...............................................................................................................................................................
University of Montreal
Home university: .............................................................................................................................................................
International Studies
Field of study:..................................................................................................................................................................
Foreseen period of the stay:
 Academic year (Mid September to the end of June)
 1st Term (Mid September to the end of January)
 2nd Term (Early February to the end of June)
Documents to join to this form (no standard required) / Documents à joindre à ce formulaire (format libre)

an official list of the results obtained so far at your university;
 a provisional list of the courses you wish to study in ULB, mentioning both codes and titles, approved by your
academic coordinator at home university [courses to pick in our 13-14 program: http://www.ulb.ac.be/programme.
Please note that you should take at least 60% of the courses, in the main Faculty where you will be registered in.

a copy of your ID or passport;

a digital ID picture (photo) format jpg - 2cm x 2,4cm

Optional: a personalized recommendation letter by an academic authority from your university.
 We remind our Incoming Students that unless scarce exceptions (e.g. some courses, or specific programs generally mentioned
to your home university when the agreements have been signed) our courses are taught in French and hence that unless
exceptions a minimum knowledge of this language is mandatory 