Fillable Inscription pour les cours en prsentiel Enrolment for

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Inscription pour les cours en prsentiel Enrolment for

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File type: PDF

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1
Inscription pour les cours en présentiel
Enrolment for courses at the Goethe-Institute
Matricule (participant number) :
Données personnelles / Personal data:
Homme (Man) Femme (Woman)
Nom (Surname):
Prénoms (Give
n names):
Date de naissa
nce (Date of birth) :
Lieu de naissance
(Place of birth):
Langue de comm
unication (Communication language) : Anglais (English) Français (French)
Ville de résidence (City of residence) :
Nr. tél. (Telepho
ne number) :
Email :
(Obligatoire)
dd
mm
yyyy
Cours / Course :
Première inscription : oui (yes)
First registration
non (no)
Date dernier cour
s au Goethe-Institut:
(
Date of last course at the Goethe-Institut)
Salle:
(Room)
Enseignant:
(Teacher)
Goethe-Zertifikat A1
(285.000 FCFA)
Goethe-Zertifikat A2
(285.000 FCFA)
Goethe-Zertifikat B1
(248.000 FCFA)
Goethe-Zertifikat B2
(248.000 FCFA)
Goethe-Zertifikat C1
(248.000 FCFA)
Handicap
: oui (yes) non (no)
(Un certificat médical est à présenter lors de l’inscription/Bring a medical Certficate at the enrolment)
Frais du cours (course fees):
2
XOF
-Bien vouloir nous envoyer un scan de votre certificat A2 si vous vous voulez faire B1/ Send a Scan of A2
certificate if you want to do B1 Course
- Bien vouloir nous envoyer un scan de votre certificat B1 si vous vous voulez faire B2/ Send a Scan of B1
certificate if you want to do B2 Course
- Bien vouloir nous envoyer un scan de votre certificat B2 si vous vous voulez faire C1/ Send a Scan of B2
certificate if you want to do C1 Course
À défaut d'un certificat, veuillez-vous approcher nécessairement du bureau de cours pour le test de niveau/ In
case you do not have a certificate, please contact the course office for a diagnostic test
Le formulaire rempli devra être envoyé à l'adresse suivante: kurse-dakar@goethe.de
(The completed Form should be sent to the following address: kurse-dakar@goethe.de )
Date paiement (Date of payment):
Montant total (total fees)
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Completed 7 July 2022

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