Exchange student application form 2015-2016

Exchange Student Application form 2015 / 2016
Please fill out this form in clear writing and send it by post, or by email to
zo.lacey[email protected]
Semester you wish to apply for:
¡ Autumn semester 200…
¡ Spring semester 200…
(mid September – End of January)
(mid February – mid June)
Application deadline for the autumn semester is May 15 and for the spring semester
November 15.
Design group you wish to apply for (Brand / Industrial Product / Global Design):
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..
Details about your home school / institution
Name of School / Institution………………………………………………………………….
…………………………………………………………………………………………………..
Name of Exchange Coordinator....................................................................................
E-mail address of contact person……………………………………………………………
Personal Details
Last name………………………………………………………………………………………
First name………………………………………………………………………………………
Date of birth (yyyy/mm/dd)……………………………………………………………………
Address………………………………………………………………………..………………
…………………………………………………………………………………........................
.......................................................................................................................................
City and postal code…………………………………………………………………………..
Country………………………………………………………………………………………….
Telephone………………………………………………………………………………………
E-mail address (please write clearly)
…………………………………………………………………………………………………..
Which department / study program are you enrolled in?…….……………………………
Year of study at the school / institution you are currently enrolled in……………………
National credits/ECTS received so far………………………………………………………
Language skills
Native language:………………………………………………………………………………
Language Skills: please assess your language level as accurately as possible using
the online europass self evaluation grid at the link below:
http://europass.cedefop.europa.eu/LanguageSelfAssessmentGrid/en
English
A1 ¡
A2 ¡ B1 ¡
B2 ¡
C1 ¡
C2 ¡
French
A1 ¡
A2 ¡ B1 ¡
B2 ¡
C1 ¡
C2 ¡
Please provide copies of any language certificates
Signatures
Signed by Exchange Co-ordinator / Head of Department or other person at your
school / institution.
I confirm that this student has been nominated, and is a suitable candidate to
undertake exchange placement at LʼÉcole de Design Nantes Atlantique.
Date: …………………………
Signature
Signature of student
L’École de design Nantes Atlantique
Atlanpole, La Chantrerie – Rue Christian Pauc - BP 30607 –
44306 Nantes Cedex 3 - FRANCE