22002Application with a foreign language.2009
Enrolment
The form below concerns your application for, and enrollment in, an educational programme offered by HZ. By your application and enrollment, you declarethat you will follow the obligatory programme of study for this eductional programme and that you wish to obtain the certificate associated with sucheducational programme.Complete the form below by filling in all the details requested and by signing it in the place indicated.
1 Personal details
Your last name1b initials of firstnames and last name
B Giroud
Your firstname1c
Bastien
Your date and place of birth1ddate of birth
20 Sep 1985
place of birth
Martigny, Switzerland
Your gender1e
Male
Your nationality1f
Swiss
Signature: I declare that this form hasbeen filled in truthfully.1hdate
19-5-2009signaturesignature of parent or guardian (if you are a minor)
2 Your Address
Do you want to receive mail at yourcurrent address or your mailaddress?2acurrent address mail addressFill in appropiate address for 2a2bstreet/house number
Rte du Léman 15
postal code/town
1906
Charrat
country
Switzerland
What is you mobile phonenumber?2ctelephone
+41797668743
3 About your diploma
What is the name of your foreigndiploma?3aname of diploma
Ecole supérieure de comme
In which year will you acquire or haveacquired the foreign diploma?3byear of diploma
2003
4 Course
Course name4c
IBMS final year bachelor degree
Course code4a
34936
Do not forget to sign and send the documents requested.
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