Montpellier SupAgro – Institut des Régions Chaudes

SUMMER SCHOOL « AGRI-CULTURES» 2017

APPLICATION FORM

1. COURSE DATES

☐ Module French language for agricultural development: from 03/07 to 21/07

☐ Module Discovering and analysing family farming: from 22/07 to 18/08

☐ Full programme (both modules one after the other): from 03/07 to 18/08

Please indicate your arrival date: date

2. PERSONAL DETAILS & CONTACT INFORMATION
Last Name: / First Name(s):

Gender: ☐ Female ☐ Male Date of Birth: Please choose date

Nationality: / Passport No.:
Address:
Postcode and City: / Country:
Mobile No.: / E-mail address:
3. EMERGENCY CONTACT INFORMATION
Last Name: / First Name(s):
Relationship:
Phone No. / E-mail address:
4. FOOD REQUESTS
Any allergies?
Any specific requirements?
5. FRENCH LANGUAGE PROFICIENCY

Please specify your French level:

☐ A0 - No proficiency at all ☐ B1 - Threshold

☐ A1 - Breakthrough ☐ B2 - Vantage

☐ A2 - Waystage ☐ C1/C2 – Proficient user

If applicable, please specify the score obtained, the certificate (e.g. DELF, TFI) and the date:

6. YOUR ACADEMIC BACKGROUND
Home university and study course
Last degree obtained :
7. YOUR STAY IN FRANCE

·  Do you intend to stay for further studies at Montpellier SupAgro after the Summer School? (please tick box)

☐ Yes ☐ No

If Yes: Name of your study programme
Level (ex: M1, M2,…)
If No: Your hosting university during 2017/2018
·  Period of stay in France:

·  Please indicate the programme you are applying for (please tick box):

☐ Full programme: French language for agricultural devt+Discovering and analysing family farming (fee 1000€*)

☐ French language for agricultural development (fee 800€*)

☒ Discovering and analysing family farming including 1 week training course (fee 350€*)

*These prices are not applicable for Agris Mundus and ACT students, neither for invited students on a special program.

·  Please indicate the type of the internship you prefer (please tick box):

☐ Goat husbandry and cheese production ☐ Mixed farming (cattle and cereals)

☐ Cattle and dairy farming ☐ Cereals and industrial crops

☐ Fruits or vegetables ☐ Olive / Wine

·  Please indicate a 2nd choice

☐ Goat husbandry and cheese production ☐ Mixed farming (cattle and cereals)

☐ Cattle and dairy farming ☐ Cereals and industrial crops

☐ Fruits or vegetables ☐ Olive / Wine

8. ACCOMMODATION INFORMATION

During the module French language for agricultural development (from 03/07 to 21/07/2017) Do you wish to apply for a room in a residence hall? Please tick box ☐ Yes ☐ No

If yes: The students are accommodated ;

-  in the residence halls at SupAgro / Main campus : https://www.supagro.fr/web/pages/?idl=19&page=574&id_page=124

Note: The rooms in the student halls are not provided with pillows, blankets, bed sheets & pillow covers, cutlery & crockery. However, you can rent all for 15€ per month.

-  or at Institut Agronomique Méditerranéen de Montpellier (IAMM): http://www.iamm.ciheam.org/fr/about/ciheam-iamm/campus , Lavalette campus

according to the place where the courses will be given (SupAgro, main campus or Institut des Régions Chaudes, Lavalette campus). The fees vary according to types of rooms.

The accommodation costs are not included in the course fee. The payment is due upon arrival.

To apply for a room, please fill in the accommodation application form and send it with the supporting documents to the accommodation office by post or by e-mail, before May 31 (see contact details on the accommodation application form).

During the module Discovering and analysing family farming (from 22/7 to 18/08) , accommodation on the field or in the internship farm is offered, hence not at the cost of the student.

9. BANK ACCOUNT IN FRANCE & RESIDENCE PERMIT

In case you stay in France for more than 3 months you will need a French bank account, e.g. in order to receive CAF allowances (CAF is a French national governmental body which provides housing subsidies): therefore a meeting concerning the opening of a bank account will be scheduled upon your arrival in Montpellier.

During this meeting we will also help you with administrative formalities to take in order to obtain a residence permit in France.

10. INSURANCE INFORMATION

·  Do you have an international health insurance that is valid in France Please tick box:

☐ Yes ☐ No

·  Do you have an international civil liability insurance that is valid in France? Please tick box:

☐ Yes ☐ No

Note: Both health and liability insurance are compulsory in France. You can purchase both on line before your arrival in Montpellier (ex.: a health insurance including repatriation and civil liability from 90€ for the period from 01/07/2017 to 31/08/2017.

By way of example:

ABCInsurance: http://www.assistance-etudiants.com/fr/page/abc

ADH Student Insurance: http://www.assurances-etudiants.com/fr/activity-0-274-275.html

If you are a national of an EU member state (or a national of Norway, Iceland, Liechtenstein or Switzerland) you are advised to apply for the European Health Insurance Card (or EHIC).

11. COURSE FEE PAYMENT INFORMATION*

A non-refundable deposit of 150€ is required to confirm the course. It must be received by May 15.

We will inform you of the mode of deposit payment by email as soon as we receive your application file.

Beware: If we do not receive the deposit we will consider that you have cancelled your registration.

The outstanding balance should be made at least two weeks prior to the course if paying by banktransfer or immediately on the first day if paying by cash or cheque.

*This section is not applicable for Agris Mundus and ACT students, neither for invited students on a special program.

12. DECLARATION

Please read the following declaration and sign it in the appropriate place below.

·  I confirm that the information given in this form is correct and accurate.

·  I have read and understood the above information.

·  In support of my application I enclose (please tick box):

☐ a copy of my passport;

☐ a copy of my health and liability insurance that is valid in France;

☐ a copy of my birth certificate (if you are staying in France for more than 2 months);

☐ the form for the authorization for use of image duly signed (see below).

Signature: / Date:

Submitting your application BY MAY 15

by E-Mail:

Enquiries
Registration :
• training programme and admission : Didier PILLOT <>
·  Insurance, opening of a bank account, residence permit: Gisèle ANDRE
Authorization for use of image

I, the undersigned,

Full name

Address

Hereby authorize Montpellier SupAgro to take pictures and films of myself during the Summer School “Agricultures” 2017.
I acknowledge and fully agree that these images and films may be published on Montpellier SupAgro website, on its social or professional media pages or on any other support for non-commercial uses.

Drawn up in (place)

On (date)

Signature

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