ESCRennesSchool of Business

2 Rue Robert d’Arbrissel - CS 76522 - 35065 Rennes cedex – France

Si tous les Ports du monde

APPLICATION FORM FOR THE INTERNATIONAL SUMMER SCHOOL IN SAINT-MALO

July 12th – 21st 2012

Limited number of places:REGISTER NOW!

Applicant, please complete: / Please add your photo here
Family name:
First name:
Nationality:
HomeUniversity:
Country:

For ESC Rennes official use only

Toefl/Ielts/Toeic score: ______ / Date of reception:
Final deadline: April 30, 2012
Signature International Studies Adviser: / Accepted:
Yes No


ONLY FULLY COMPLETED APPLICATION FORMS WILL BE CONSIDERED.

PLEASE COMPLETE IN BLOCK CAPITAL LETTERS

1. Personal information

TITLE: Mr Mrs Ms

FAMILY NAME OR SURNAME:

FIRST NAME(S)

GENDER: Male Female

POSTAL ADDRESS FOR CORRESPONDENCE

N° STREET:

ZIP CODE: CITY: COUNTRY:

TELEPHONE: MOBILE 'PHONE:
(Country Code/Area Code/Telephone)(Country Code/Area Code/Telephone)

E-MAIL 1: E-MAIL 2:

Please write your e-mail address very clearly in case we need to contact you

DATE OF BIRTH: /_/ _/19

(Day) (Month) (Year)

CITY OF BIRTH: COUNTRY OF BIRTH:

NATIONALITY: MOTHER TONGUE:

2. Educational background

2.1Sending Institution (where you are registered today)

Name of School/University / Location
(City,Country) / Date of Entry
(Month/Year) / Expected date
of Completion
(Month/year) / Name of Diploma or certificate prepared / Please tick here if the programme was taught in English

2.2. Post secondary Schools and Universities

Name of School/University / Location
(City,Country) / Date of Entry
(Month/Year) / Date of Completion
(Month/year) / Name of Diploma or certificate obtained / Please tick here if the programme was taught in English

3. Employment information

Please list all recent and relevant employment or internship experience:

Period

/ Employer
(Name/City/Country) / Job Title / Responsibilities

4. Language proficiency

4.1 English language:

The programme is conducted in English.

If you are a non native English speaker, a good command of English is required (indicative IBT toefl score: 80)

TOEFL (score) IELTS (score) TOEIC (score)

Other test: ______(score)

4.2 French language:

No French is required but please encircle the letter which best corresponds to your written and oral level in French if any:

Native language / Fluent / Good working knowledge / Conversational / Non-existent
French / A / B / C / D / E

5. International experience(if any)

Year / Length of Stay / Country / Reason

6. Interest and motivation

Please explain your interests and motivations forattending the International Summer School in Saint-Malo

To be enclosed:

Don’t forget to create a presentation, an object (a video, a painting or whatever.… ),

this is your choice !

…In order to present your vision of your maritime region in 2020

7. Miscellaneous

Please give us all extrainformation we need to know (e.g. physical handicaps, etc...)

8. Person to contact in case of emergency

Name:

Address: Zip code: City: Country:

Telephone: Mobile: Email:

9. Application procedure: REGISTER NOW!

Number of places limited to 20 !

  • Application deadline

Final deadline: April 30, 2012

The selection process will take place within 7days after the deadline so as to let you know whether your application has been accepted and make travel arrangements.

10. Visa and insurance

  • Visa procedure:

A letter of acceptance will be provided for visa purposes. It is the student’s responsibility to ask for a tourist visa as soon as possible at the nearest French Embassy or Consulate

  • Insurance

It is the student’s responsibility to have subscribed tocomprehensive medical coverage for the entire stay in France / Europe (including civil responsibility)

11. Costs: expenses in Saint-Malo/ Dinard : covered

  • Accommodation and board in Dinard from July 12 to 22 2012:

All expenses are covered on site; no costs for the students

  • Visa, insurance,Transportation

It is the student’s responsibility to cover those expenses or to find sponsors.

12. Verification

I certify that I have read and understood the guidelines for filling out this form and that the information provided on this form is complete and accurate

Date:...... Signature:

Completed application form should be returned to the appropriate office:

By email:

Please send the application form to:

Application Closing date: April 30, 2012

ESCRENNESSCHOOL OF BUSINESS

CS 76522, 2 rue Robert d’Arbrissel, 35065 Rennes Cedex, France

Telephone: (33) (0)2 99 54 63 63, Fax: (33) (0)2 99 33 08 24

Website:

ESC Rennes is committed to a policy of equal opportunity in student admissions

without regard to race, colour, religion, sex, national origin, age, marital status or handicap.

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