e-Academy.25 (GP) - Application Form

Personal information

Please complete all fields.

Last/Family name(s)*

First/Given name(s)*

Gender*

Female

Male

Not applicable

Mother tongue*

Country of birth*

Date of birth*

You should be at least 18 years old at the beginning of the programme to apply.

Nationality*

Passport number*

Please upload a scanned copy of your passport*

→ specifically the biopage

Max. file size: 10 MB.

Please upload a high-quality picture of you*

→ choose an ID-type of photo

Max. file size: 10 MB.

Email address*

Enter Email * Confirm Email *

Your address

Do you already know at what address you will be staying in France ?*

Yes

No

Your address in France*

Postal address * City * State / Province / Region * Postcode * Country *

Address in your home country (if any)

Street address City Region Postcode Country

Address in your home country*

Postal address * City * State / Province / Region * Postcode * Country *

Phone (mobile)*

Phone (landline)

Emergency contact

Last/Family name(s)*

First/Given name(s)*

Relationship with you

Email address*

Phone*

Will you be in France during the whole programme e-Academy.25 ?*

Yes

Non

Please state which country you will be in for an optimal organisation of your training*

(NB: should you move to France during the programme, since the attendance is obligatory, please make sure you travel on a Saturday or on a Sunday)

To facilitate the organisation, please indicate below any condition that could affect your training

(defective or used equipment, limited internet access, visual impairment...)

Consents

Privacy Policy*

I agree to the Privacy Policy as laid out below

Personal data security – Data Protection Act
The collected data is computer-processed in order to coordinate and execute the summer programmes organised by the International Academy.
The recipients of the data are the staff of the International Academy. Only the data required for accommodation booking are passed on to the institutions or partner organisms for the sole purpose of carrying out their mission.
In compliance with current French regulations, you have the right to access and modify and, under certain conditions, to delete, limit or oppose these data. Should you wish to exercise one of these rights and/or obtain disclosure of the data that concern you, please contact directly the Data Protection Officer of the University of Lille: dpo@univ-lille.fr.

Training Charter*

I agree to the Training Charter as laid out in this document

Terms & Conditions*

I agree to the General Conditions as laid out below

REGISTRATION
The registration deadline is July 1^st 2023.
If the completed Registration form and the supporting documents are received, the International Academy will send you a confirmation email.
The registration becomes legally binding with this confirmation. You thereby accept the cancellation conditions outlined below.
CANCELLATION/EXCLUSION/REFUND
The International Academy reserves the right to exclude the participant should they not abide by the Training Charter. In that case, no tuition fee will be refunded.
The International Academy reserves the right to cancel the session in case of force majeure. If applicable, the decision will by emailed to the participant in due time. Should such cancellation be necessary, the participants concerned will receive a full refund of all tuition fees paid up until that point.
These Terms and conditions are subject to the law of France. In the event of a dispute over their interpretation, such dispute shall be settled though amicable proceedings between the parties. If no amicable agreement is reached, the Administrative Court of Lille shall have sole jurisdiction.

Email

This field is for validation purposes and should be left unchanged.

e-Academy.25 (Graduate Programmes)

Academy.25 - Application Form

Personal information

Your address

Emergency contact

Details of your studies in your home country

Your international mobility in France

Details of your studies in France

French language

English language

Consents

Contact us