Student Application Photo

Form
International Student Exchange
Programmes

This application should be completed in BLACK PRINT in order to be easily copied and/or faxed.
Please note that we will only proceed complete applications.
Academic Year : Period of study : Duration of stay :
from: one semester’s study
to: one semester’s study + training period
one year’s study
laboratory project
double degree
Field of Study:
Biological Engineering Computer Engineering Mechanical Systems Engineering
Mechanical Engineering Chemical Engineering Urban Systems Engineering

 Receiving Institution
Name: Université de Technologie de Compiègne - Directorate International
Relations
Address: Rue Roger Couttolenc, BP60319, 60203 Compiègne Cedex, FRANCE

Incomings Advisor: Incomings Coordinator:

Name: Erica VICTORINO Name: Céline DE ARAUJO
Phone: 0033 (0)3 44 23 73 96 Phone: 0033 (0)3 44 23 73 99
Fax: 0033 (0)3 44 23 73 88 Fax: 0033 (0)3 44 23 73 88
E-mail: erica.victorino@utc.fr E-mail: celine.de-araujo@utc.fr

 Sending Institution
Name:
Address:

Departmental Coordinator: Institutional Coordinator:

Name: Name :
Phone: Phone:
Fax: Fax:
E-mail: E-mail:

 Student‘s personal data

Family
First name:
name:
Date of Place of
birth: birth:
Nationality: Sex:

Current correspondence address: Permanent home address: (if different)

Street: Street:

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Post Code: Post Code:
City: City:
Country: Country:
Phone: Phone:

Mobile: E-mail :

Current address is valid

E-Mail:
until:
Name of Student:
Sending Institution : ERASMUS-Code: Country:
Receiving Institution : Université de Technologie de
ERASMUS-Code: F compieg 01 Country: France
Compiègne

 Language skills
Mother tongue:
Language of instruction at the
home institution:

Other Languag I am currently studying this I have sufficient I would have sufficient
language e language: knowledge to follow knowledge to follow
s: proficien lectures: lectures if I had some
cy level extra preparation:
(as
confirme
d by
sending
institutio
n)
Yes Yes Yes
No No No
Yes Yes Yes
No No No
Yes Yes Yes
No No No

 French Intensive course

UTC organizes a free French intensive course for 4 weeks
I would like to attend the French intensive course that will run: Fall semester (August 3th to August 28th,
2015)

Spring semester (January to February 2016)

 Previous and current studies

Higher education study years prior
to departure abroad:
Degree for which you are currently
studying:
Date when you began these
studies:
Date when you expect to complete
them:
Have you already been studying
Yes No
abroad?
If yes, when and at which
Institution?

 Work experience related to current study (if relevant for the study abroad)

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Type of Firm / Organisation: Dates: Country:
work
experience

 Motivation
Briefly state the reasons why you wish to study abroad :
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The Application form must be returned to us before May 1st for the fall semester, and November 1st
for the Spring Semester, with the following documents: a CV, official transcripts from your home
university and a selection of credit courses you intend to follow at UTC

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Name of Student:
Sending Institution : ERASMUS-Code: Country:
Receiving Institution : Université de Technologie de
ERASMUS-Code: F compieg 01 Country: France
Compiègne

 Details of proposed study programme abroad / Learning

Agreement
Course code Course title (as indicated in the information package) ECTS
and page no. credit
of the
information
package

Please note that all changes in the learning agreement must be approved by the departmental
coordinator at the home institution. The formular foreseen is available

I agree that these data will be stored and processed electronically and transmitted to the universities
concerned exclusively for the purpose of my ERASMUS-application.

Student’s signature: Date:

To be completed by the office:

Sending Institution: We confirm the approval of this application and the recognition of the proposed
study programme at our institution

Departmental Coordinator’s signature: Date:

Institutional Coordinator’s signature: Date:

Université de Technologie de Compiègne: We hereby acknowledge receipt of this 3 pages

application form and the candidate’s Transcript of Records.
The above mentioned student is: £ accepted at our institution £ not accepted at our institution

Departmental Coordinator’s signature: Date:

Institutional Coordinator’s signature: Date:

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Name of Student: Period abroad: to
Sending Institution : ERASMUS-Code: Country:
Receiving Institution : Université de Technologie de ERASMUS-Code: F compieg
Country: France
Compiègne 01

 Changes to original proposed study programme/learning agreement

(to be filled only if appropriate)

Deleted course uniit

Course code

Added course uniit

and page no.
of the Course title (as indicated in the information package) Number of
information ECTS Credit
package

Please note that all changes in the learning agreement must be approved by the departmental
coordinator at the home institution. This is the formular foreseen. It shall be brought to the partner
institution and used if appropriate.

Student’s signature: Date:

To be completed by the offices:

Sending Institution: We hereby confirm the above-listed changes to the initially agreed programme
of study/learning agreement are approved

Departmental Coordinator’s signature: Date:

Institutional Coordinator’s signature: Date:

Université de Technologie de Compiègne: We hereby confirm the above-listed changes to the

initially agreed programme of study/learning agreement are approved.

Departmental Coordinator’s signature: Date:

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Institutional Coordinator’s signature: Date:

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