Fillable SUMMER 2021 Student information (Ecole Supérieure de Chimie Organique et Minérale)

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SUMMER 2021 Student information (Ecole Supérieure de Chimie Organique et Minérale)

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French forms for Ecole Supérieure de Chimie Organique et Minérale

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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 : ____________________@___________________
Studies
Number of years completed in higher education: __________
Current studies (2020-2021) :
Degree : _______________________ Field of study : ________________
Past studies (if applicable) :
Degree(s) obtained : ___________________________ Year :_______ Field of study:_____________
APPLICATION FORM
SUMMER 2021
Languages
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:____________
Remote programme
IMPORTANT - We intend to hold this summer programme on-campus. However, we are aware that
the current health situation could still have an impact on mobility by June. In case you’re admitted
and you couldn’t be authorized to travel, we are considering to switch to a remote programme. In
this case, you will be informed at the beginning of May. Would you be interested to attend the
remote programme ?
☐ Yes ☐No
Please note that the remote programme cannot include visits of companies and cultural outgoings
but alternative online activities will be proposed. The cost will also be reviewed accordingly.
Documents to be sent with the application
Enrolment certificate from your home university for academic year 2020/2021
Copy of ID/Passport
Transcripts of records for all university studies
CV
Proof of English language proficiency
Proof of French language proficiency if applicable
Statement
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
international@escom.fr
by 5
th
May, 2021. Please feel free to use this email address for any further
information.
If your application has been accepted, you will have till 31
st
May, 2020 to do the payment – by bank
transfer only - to confirm your registration and accommodation reservation. Regarding the current health
situation, we don’t recommend to do the payment too early.
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 1
st
: 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 31
st
Confirmation of pick-up arrangements upon arrival will be sent to applicants before arrival.
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SUMMER 2021 Student information (Ecole Suprieure de Chimie Organique et Minrale)

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Completed 30 January 2021

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