Student information
First name : _________________________________ Last name : _________________________
Permanent address :_________________________________________________________________
City: ________________________________ ZIP/Postal code : _____________________________
Country: _______________________ Nationality: ______________________________
Mobile phone (+ country code) : +________ _______________________________
Email : ____________________@________________
Gender : Male Female
Date of birth : DD/MM/YYYYY Country of birth: ____________________________
Do you have any disability/special needs ?: Yes :______________________ No
Do you have special food diet or requirements (vegetarian, only some meats, allergy nut, fish…)? :
Yes, please precise exactly:__________________________ No
Academic background
Home university : _________________________________________
Is your university partner of ESCOM Chimie ? Yes No
Contact at home university (academic, international office…) : _______________________________
Phone : +_____ ___________________ Email : ____________________@___________________
Number of years completed in higher education: __________
Current studies (2019-2020) :
Degree : _______________________ Field of study : ________________
Past studies (if applicable) :
Degree(s) obtained : ___________________________ Year :_______ Field of study:_____________
English language proficiency : Native language
Accreditation test (TOEIC, TOEFL, IELTS…) : _________________ Score : _________________
French language proficiency : Fluent Advanced Intermediate Beginner None
Accreditation test if applicable (DELF, DALF, TEF, TCF…): ____________________ Score : __________
Could you please state briefly what are your motivations and expectations for joining this
programme ? (in a separate document if you prefer) Please precise if you have any previous
experience/courses in formulation and cosmetics science :
How did you learn about ESCOM Chimie ?
International relations of your university Your faculty at university
Students from your university Other students
Website Internet/ Social networks Flyer Other:____________
Documents to be sent with the application
Enrolment certificate from your home university for academic year 2019/2020
Copy of ID/Passport
Transcripts of records for all university studies
Proof of English language proficiency
Proof of French language proficiency if applicable
I hereby certify that the information given above is accurate and complete.
I understand that ESCOM Chimie reserves the right to withdraw any application, should any statement in
this form prove to be false.
Date :
Signature :
This application form has to be sent with required attachments by email to
by 5
May, 2020. Please feel free to use this email address for any further
If your application has been accepted, you will have till 15
May, 2020 to do the payment by bank
transfer only - to confirm your registration and accommodation reservation.
Application and fees
Special fee for students from partner universities : €1.850
Fee for students from other universities : €2.350
Fees include :
Transfer from Compiègne train station to your accommodation according to the schedule
Accommodation during 3 weeks including internet access (dishes, towels and bed linen provided)
Lunches during the week
Cultural and business visits (transport with bus + entry tickets) included in the programme
Weekly French language courses
Buses are free in Compiègne.
Fees don’t include :
Travel costs to France and overnights outside booking period in Compiègne
Transfer to Compiègne and transports around Compiègne
Personal insurance and civil liability
Breakfast and dinners
Meals during the weekends
Visa fees
Personal expenses
Application process & timeline
By May 5th: Please complete the Application Form
ESCOM will send the decision concerning your application and send bank details for the payment
Upon confirmation of acceptance, final deadline for payment is May 15
Confirmation of pick-up arrangements upon arrival will be sent to applicants before arrival.