Please fill out this form electronically and send your documents per email to:


For your information:
UniLaSalle (former Institut Polytechnique LaSalle Beauvais)
International Direction – Incoming Students
( +33 (0)3 44 06 38 14
+33 (0)3 44 06 25 26
19 rue Pierre Waguet / B.P. 30313
60026 BEAUVAIS Cedex – FRANCE
http://international.lasalle-beauvais.fr/-Study-at-LaSalle-Beauvais- / Cooking for Health:
from field to plate
ACADEMIC YEAR: 2016/2017
Application deadline: February 15th, 2017

General information

Last name:
/ Date of birth (D,M,Y):
Town of birth:
Country of birth:
First name(s): / Gender: Female
Male
Nationality: / Mother tongue:
Current personal address:
Street & number: ………………………………………………………………………………………………
City: ……………………………………………………………….… Postal code: ………………………...
Country: ……………………………………………….. / Cellphone:
E-Mail (personal):
Person to contact in home country in case of emergency (name, phone number and e-mail address):
Home university: (full name and full postal address)
Faculty / College: / Erasmus+ code
for European Universities
………………………………….
Contact person at home university: (name, tel., e-mail address, faculty)
Contact person at home university to send the transcript of records (if different from contact above) (name, tel., fax, e-mail address, faculty)
In case of emergency:
-  Do you have health concerns other than food-related?
………………………………………………………………………………………………………………………………………
-  Do you have any dietary restrictions based on medical, cultural or religious reasons?
………………………………………………………………………………………………………………………………………
-  Do you have any allergies?
………………………………………………………………………………………………………………………………………
Dietary restrictions for cultural or religious reasons:
French cuisine has been declared “world intangible heritage by” UNESCO. It is based on a variety of fresh, seasonal ingredients that include meat (including pork and poultry), shellfish , (non-pasteurized) dairy products, soy, nuts and alcohol.
Please be aware that during this program, and especially during a restaurant internship, you will be expected to work with recipes that may contain these food items.
I have read and understand the above statement and agree to abide by its terms while I am participating in the short program.
Signature: ………………………………………………………………………………………………….

Academic background

Last degree obtained (name, year, level and location):
Current level / year / major-minor in your home university:
Cumulative GPA:
Have you studied in France before?: Yes No
If yes:
-  Academic institution & Town:
-  Degree/Major:
-  Dates :
-  Number INE (Identification National Etudiant) if you know it:
Knowledge of languages:
French
English
Other ……………...... / Excellent Advanced Intermediate Basic (oral)
Excellent Advanced Intermediate Basic (written)
Excellent Advanced Intermediate Basic (oral)
Excellent Advanced Intermediate Basic (written)
Excellent Advanced Intermediate Basic (oral)
Excellent Advanced Intermediate Basic (written)
Other skills / experiences (for restaurant internship, basic culinary skills are mandatory):
  International Driving License
  Acquired culinary skills: if so please explain on a separate sheet
  Farm experience: if so please explain on a separate sheet
  Experience in restauration or catering: if so please explain on a separate sheet

Documents to be provided

Official copy of exam of:

* English language - 785 TOEIC level as a minimum (if you are not a native speaker of English)

Transcript of records of the 3 last years from the home university (in English or French)

1 résumé (Curriculum Vitae)

A personal statement of interest: what motivates you to come to this program? (250-words)

If applicable, evidence of basic cooking skills (mandatory for restaurant internship)

Learning Agreement - Duly completed & signed by your home coordinator and yourself

1 passport copy with photo

1 photo – ID format for your future student card

Proof of international Health Insurance coverage

·  For non-European students, you have to subscribe a special health insurance in your country covering you during your whole stay in France.

·  For European students, you need to send us a copy of your European Health Insurance Card.

Proof of Liability Insurance coverage

·  For non-European and European student, you have to subscribe to a liability insurance in your country covering you during your whole stay in France

Page 1 sur 3

Application form UniLaSalle