ISARA-Lyon

23 rue Jean Baldassini

69364 Lyon cedex 07

International Relations Office:

Sigolène VERNERET

+33 (0)4 27 85 85 10

E-mail:

This form must be completely typed, signed, scanned and sent by email

Application deadlinesFall Semester: between April 15th and June 1st
Spring Semester: between September 1st and October 15th
Year: between April 15th and June 1st
Arrival dateDeparture date:
Last name: / Date of birth (D, M, Y):
Place of birth (City and country):
First name (s): / Gender:FemaleMale
Nationality: / Mother tongue:
Permanent address:
Street & number:
City: Zip code:
Country:
Tel: E-Mail:
Person and telephone number in home country to contact in case of emergency:
Name: Tel: E-Mail:
Home University:
Complete address (Street, number, zip code, city, country):
Name of the exchange coordinatorof your university:
Telephone number: E-Mail:
Knowledge of languages according to the Common European Framework of References
French:
UnderstandingC2C1B2B1 A2
SpeakingC2 C1 B2 B1 A2
Writing C2 C1 B2 B1 A2
English:
UnderstandingC2 C1 B2 B1 A2
SpeakingC2 C1 B2 B1 A2
Writing C2 C1 B2 B1 A2
Others:Please precise
UnderstandingC2 C1 B2 B1 A2
SpeakingC2 C1 B2 B1 A2
Writing C2 C1 B2 B1 A2
Please add to this application form a copy of all your official tests
Type of Exchange Programme
ERASMUS Bilateral institutional exchange Other (please specify):

LEARNING AGREEMENT

Please consult the International Student Guide on our website

Admission will not be granted unless this section is fully completed

Student’s name:
Home institution:
Country: Specialization of study chosen: CHOOSEAGRICULTURE, ENVIRONMENT AND RESOURCE MANAGEMENTAGRIFOOD, FOOD AND INDUSTRIAL MANAGEMENTMARKETS AND CORPORATE MANAGEMENTSUSTAINABLE RURAL DEVELOPMENTVITI-VINI
Number of ECTS credits to be obtained at ISARA-Lyon:
Current level of studies:
Bachelor 1st year 2nd year 3rd year 4th year
Master 1 Master 2
Tick the equivalence if your are in an engineer curriculum / Diploma/degree expected:
Bachelor MasterEngineer
Date:

INTENDED STUDY PROGRAM

COURSE UNIT / DURATION / NUMBER OF CREDITS
Code
(indicated on ECTS Guide) / Title / Start / End
TOTAL

(if necessary, continue this list on a separate sheet)

RESEARCH if necessary (Subject to approval)
Field / Laboratory
Further remarks for the study plan
I agree to take all exams
related to the course / Student’s signature: / Date:
I hereby approve the above plan of study/learning agreement: / Sending Institution Coordinator’s signature:
Name, signature and stamp of the institution / Date:
I hereby approve the above plan of study/learning agreement: / Receiving Institution / Date:
International Relations:
Sigolène Verneret / Education Department:
Alain Gay or Séverine Stéphany

ISARA-Lyon – Guide ECTS2014-2015 1

LETTER OF INTEREST

To be written in French if you plan to attend most of your scientific classes in French.

To be written in English if you plan to attend most of your scientific classes in English.

Please indicate in this letter (maximum one page):

-The reasons for applying at ISARA-Lyon,

-The reasons for applying to a particular specialization of study

-If you want to do an internship, indicate in which structure and what kind of internship you are looking for, why, and your experience in this related field.

ACCOMODATION APPLICATION FORM

Accommodation will be given on a first come first serve basis and according to ISARA’s possibility.

Remember that once ISARA-Lyon gives you a confirmation about the housing you chose, you are committed for the whole period of your stay. Please refer to the International Student Guide on our website for detailed information.

Last name:
First name:
Person to contact in case of emergency: / Name: / Telephone:
E-mail:
Period: / Fall semester: August/September to December
Spring semester: January to June / July

Please rank housing proposition according to your preference:1 = favourite – 7 = least favourite

For more details on the different choices (price, location, …), please check the Course Guide for International Students on our website.

ISARA-Lyoncan book it for you / ISARA-Lyon might have some possibilities / I prefer looking for my own place to live
ALLIX Crous Residence
Room / ALLIX Crous Residence
Studio / DELESSERT Crous Residence
Room / LaMADELEINE
Crous
Residence
Room / Family / Lyon Expat families / Private Residence / Flat to share
I agree to pay all deposit, file, reservation and insurance fees requested. I also agree to fully comply with all regulations concerning accommodation.
Signature and date:

CERTIFICATE OF KNOWLEDGE OF THE FRENCH LANGUAGE

To attend scientific courses in French a B1 Level according to the Common European Framework of Reference for Languages, is required.

Designated University Official of the home institution:

Function:

Email address: Phone number:

Home University: Country:

Hereby certifies

that the student (first name and last name):

under the: Student Exchange Program from

(Name of the programme) (School / Faculty / Department)

has reached the required level of French so as to follow lectures and take examinations during his/her study period at ISARA-Lyon, France.

Other remarks:

Please add any other document proving the level.

Place & Date: Signature & stamp of the Institution:

CERTIFICATE OF KNOWLEDGE OF THE ENGLISH LANGUAGE

Please fill in this form if you want to attend courses in English.

To attend scientific courses in English a B1 Level according to the Common European Framework of Reference for Languages, is required.

Designated University Official of the home institution:

Function:

Email address: Phone number:

Home University: Country:

Hereby certifies

that the student (first name and last name):

under the: Student Exchange Program from

(Name of the programme) (School / Faculty / Department)

has reached the required level of English so as to follow lectures and take examinations during his/her study period at ISARA-Lyon, France.

Other remarks:

Please add any other document proving the level.

Place & Date: Signature & stamp of the Institution:

INSURANCE COVERAGE

Please refer to the International Student Guide on our website for detailed informationon insurance.

For non-European:

Please tick one of the two propositions below:

* I attest that I will subside to the mandatory French Students’ Health Care Insurance (213 € price for 2014-15)
* Concerning complementary insurance, I certify that I have my own insurance covering:
- Medical costs & hospitalisation yes no
- Civil liabilityyes no
- Repatriation yes no
- Work accidents yes no
- Other:
Iattached to my application a copy of my contract valid for your whole period in France.(Cf. example p.9)
Date and signature:
* I attest that I will subside to the mandatory French Students’ Health Care Insurance (213 € price for 2014-15)
* Concerning complementary insurance, I prefer to subside to a French one once I’ll be in Lyon.
Date and signature:
To be signed once in Lyon:
I the undersigned,______(name and surname) attest that I received all necessary information about complementary insurance and I’m responsible to subside to any complementary insurance recommended by ISARA-Lyon.
Date and signature:

For European

* I attest that I will bring my European Health Insurance Card with the appropriate expiry date.
If I’m not able to bring my European Health Insurance Card, I attest that I’ll subscribe to the mandatory French Students’ Health Care Insurance.
(213 € price for 2014-15)
Date and signature:

Please tick one of the two propositions below:

* Concerning complementary insurance, I certify that I have my own insurance covering:
- Medical costs & hospitalisation yes no
- Civil liabilityyes no
- Repatriation yes no
- Work accidents yes no
- Other:
Iattached to my application a copy of my contract valid for your whole period in France. (Cf. example p.9)
Date and signature:
* Concerning complementary insurance, I prefer to subside to a French one once I’ll be in Lyon.
Date and signature:
To be signed once in Lyon:
I the undersigned,______(name and surname) attest that I received all necessary information about complementary insurance and I’m responsible to subside to any complementary insurance recommended by ISARA-Lyon.
Date and signature:

EXAMPLE OF PROOF OF INSURANCE COVERAGE

(to be completed by the insurance company)

We

(Name and address)

hereby certifythat Mr / Miss / Mrs:

(Last name)(First name)

has been provided with the adequate compulsory insurance coverage for:

- Medical costs & hospitalisation yes no

- Civil liabilityyes no

- Repatriation yes no

- Work accidents yes no

- Other:

during his/her study period at ISARA-Lyon – France

Fromto(day / month / year).

(Please join a copy of the procedure to be followed, should arise the need)

Place & Date:Signature & stamp:

Your own private insurance won’t prevent you from having to subscribe to the French students’ health care if you are not a EU-citizen or a EU-citizen without a European Health Care Card.

For more information please consult the International Student Guide on ourwebsite

CHECK LIST

Your application is complete once you have filled out this application form and added all required documents, please check:

First page application information

Learning agreement

Letter of interest (in French if most of courses you will attend are in French

Accommodation application form

Certificate of knowledge of French language + English language

Official Language tests

Insurance coverage

Additional documents required:

A copy of your passport

A copy of your birth certificate

Yourcurriculum vitae(in French if most of courses you will attend are in French)

A copy of your Bachelor Diploma

Grades for the last 3 years

1 scanned passport picture in .jpeg format

I attest that all documents are valid

Date and Signature

ISARA-Lyon – Guide ECTS2014-2015 1