/ European SUMMER PROGRAM
APPLICATION FORM
ESP 1 – JUne 2 – JUne 27 2014

Application Instructions & Checklist

Completed Application Packages must be received by: 15 April 2014

Instructions:

Please COMPLETE(either on-line OR print and complete hard copy), SIGN and DATE the application form.

Send completed application package (application form + required documents + proof of deposit) to:
European Summer Program
International Office
Université Catholique de Lille
60 boulevard Vauban
BP 109
59016 Lille Cedex
France
Or (with scanned documentation)

Please allow 3-4 weeks for processing. Failure to submit all required documentation and necessary deposits (in euros) with this application form may lead to delays in processing. Complete paper application package only will be processed.

Application Package Checklist:

A completed ESP application form

a passport-sized ID picture (by e-mail in jpg format to )

a photocopy of your passport – picture + identification (by regular mail, fax or email)

The completed “Council of Europe’s Assessment Grid” for French courses

Students taking Science and Engineering courses only:

Please attach a list of courses taken at your home university together copies of relevant transcripts. This is not for selection purposes but so that we are aware of student profiles and can make any necessary adaptations to the courses.

The payment for the program:

Payment Options (choose one):

Credit Card – please fill in the Credit Card Form and attach it to your application

Bank transfer – please fill in the Bank Transfer form and attach it to your application

Cheque – payable to the Fédération Universitaire et Polytechnique de Lille

(PLEASE DO NOT SEND CASH)

USE OF THIS FORM:

2 options:

  1. Complete form on-line and email it + all scanned documentation to .
  2. Print and complete a hard copy, fill it in and send or fax it + all documentation to the ESP Office.

ALL SECTIONS OF THIS FORM MUST BE COMPLETED

Upon receipt of a complete paper application package, eligibility will be determined.

A letter of admission will be emailed directly to accepted students.

Personal Information and Mailing Address

Protection of Privacy- The personal information requested on this form is collected under the authority of the Loi “Informatique et Libertés” and will be protected. It will be used for the purpose of administering study abroad programs only.

Last (family) Name
First Name
Date of Birth(dd / mm / yyyy)
Country of Citizenship
Gender / Female Male
Address
(Street Address,
Apartment Number,
Box Number)
City or Town
Country
Postal or Zip Code
Home Phone Number
Permanent Email (will be used to send your admission letter)

Emergency Contact Information

Name
Relationship to Student
Address
City
Postal or Zip Code
Country
Home Phone Number
Cell Phone Number
Fax Number
Permanent Email

Academic Information

  • Course selection

Students at the ESP are registered in the elective they have selected on a first come first served basis.

Université Catholique de Lille cannot guarantee placement in any elective so you are required to select at least one alternate courseto allow for some degree of flexibility in your selection.

If your first choice is not available, then you will be advised and allocated your second choice.

Please indicate the track you are applying for as well as an alternate course (choose below).

General Program
Elective / European Integration / Please selectFirst ChoiceSecond ChoiceNot interested
European Business and Management / Please selectFirst ChoiceSecond ChoiceNot interested
French Arts in Europe / Please selectFirst ChoiceSecond ChoiceNot interested
World Class Museums between Paris and Brussels / Please selectFirst ChoiceSecond ChoiceNot interested
Expression et Civilisation Française / Please selectFirst ChoiceSecond ChoiceNot interested
La France et son Cinéma / Please selectFirst ChoiceSecond ChoiceNot interested
  • French Classes

You do not require any French pre-requisites to participate in this course.

Although you will be tested on arrival in Lille, it would be helpful in preparing the levels, if you could complete the attached Council of Europe’s Assessment Grid and alsoanswer the 2 following questions:

I estimate that my level in French is
I have taken / Please indicate the number of semesters of French
Other:
  • Optional Services

Battlefields of WW1 / + 65 euros / Yes No
French Conversation / + 100 euros / Yes No
Health And Travel Insurance / + 75 euros / Yes No, I’ll arrange my own insurance
  • University

University of Origin
Year of Study
Address
Country
Email address
Contact person
Major
Minor

Practicalities

Check-in / check - out
1st June / 26 June
  • Specific needs:

Have you got any disability or specific needs? No Yes (please specify: )

Specific health problems? No Yes

(Please specify:

medication: )

Diet: If you have a particular diet (vegetarian, vegan, other), please specify here:

Whilst the ESP can make no diet any guarantees, we will take this information into account as far as possible.

  • Any Other Business:

Have you ever studied abroad? No Yes (where and for how long? )

How did you find out about the ESP? / Please select:ESP webpagePosterFlyerInternet searchFaculty or Study AbroadFriendCampus France website/catalogue

Student's Signature

After carefully reading the details of the European Summer Programs of Lille Catholic University, I have decided to apply.

I certify having subscribed to travel and health insurance for the duration of my stay in France.

I have read and agree to the ESP Regulations ( + link).

I have read and agree to the ESP Terms and Conditions + link

Date / / / (dd/mm/yyyy)
Print Name
Signature

THANK YOU FOR YOUR APPLICATION TO

THE EUROPEAN SUMMER PROGRAM.

WE ARE LOOKING FORWARD TO MEETING YOU!