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ECOLE NATIONALE DINGENIEURS DE SAINT-ETIENNE

NATIONAL ENGINEERING SCHOOL OF SAINT-ETIENNE

APPLICATION FORM 2016-2017 International student *

* This form is to be sent back to the ENISE at following address : international@enise.fr

PERSONAL DETAILS

Title : Mr, Mrs, Miss : Mr

SURNAME (Family name) : Carcache .....

First name (Name given) Pablo

Date of birth : ..10.../...22.../..1983......Place of birth : Campana........Country of birth Argentina

Nationality : .Argentina

Marital status (Unmarried married) : Unmarried

SURNAME and First name (Father) : Carcache.............................

SURNAME and First name (Mother) : Rios Sanchez...............................

Correspondence address in your home country

Address of your parents : cordoba 235..............................................................................................................................

Postcode : 2804 City: Campana....................Country: Argentina.................................................................................

Phone number :+54 03489 440729............................Mobile : :+54 03489 15543784...........................................................

E-mail, where you can be reached at any time, even during holidays pablocarcache@hotmail.com

During your stay in France

Address : ..............................................................................................................................................................................

................................................................................................................................................................................................

Phone number :................................................................. Mobile : ...........................................

Do you know a person to be contacted in France in case of emergency ?

Specify the relation (next of kin, friend, other)..................................................................................................................

Please let us know his/her address and phone number.........................................................................................................

Title...................Family name..................................................First name.................................

P.T.O

ECOLE NATIONALE DINGENIEURS DE SAINT-ETIENNE

58, Rue Jean Parot 42023 Saint-Etienne cedex 2 FRANCE
Tl 33(0)4 77 43 84 84 - Fax 33 (0)4 77 43 84 99 www.enise.fr
 STUDIES AT ENISE
Mechanical Engineering (GM) Civil Engineering (GC)

3rd 4th 5th year Master

Your stay : from................./................./..20.....................................to.............../......................./......20 ....................

Framework :
Erasmus exchange Bilateral agreement Free mover

Purpose :
Erasmus mobility (ECTS)

Academic period

Double Diploma

Engineering degree (2 years)

Industrial training period

Final year project

Master programm (research)

Thematical short program (COOPERA)

ACADEMIC INFORMATION

High school diploma / A Levels / Baccalaurat *:

Title: ........................................................................................................................................................................................

Shool: .....................................................................................................................................................................................

Date obtained :

BACHELOR (Highest qualification, diploma or degree obtained)*:

Title: ........................................................................................................................................................................................

University or Institution Town & Country : ............................................................................................................................

Date obtained :

MASTER (Highest qualification, diploma or degree obtained) *:

Title: ........................................................................................................................................................................................

University or Institution Town & Country : ............................................................................................................................

Date obtained :

CURRENT STUDIES : provide a copy of your transcript of records

Title & level of study : .............................................................................................................................................................

University or Institution Town & Country : ............................................................................................................................

Expected date of graduation :

* provide a copy of all these degrees

provide a copy of all your transcript of records from university level

ECOLE NATIONALE DINGENIEURS DE SAINT-ETIENNE

58, Rue Jean Parot 42023 Saint-Etienne cedex 2 FRANCE
Tl 33(0)4 77 43 84 84 - Fax 33 (0)4 77 43 84 99 www.enise.fr
 LANGUAGE ABILITIES AND EXPERIENCES
Level in French : read ?.................written ?...................spoken. ?..............Understanding of a conversation ? .........

How many hours of French lessons ?............................

If you have any result from an international test, please give us your score ?................................

Have you made any long visit to France before ?..................Please give dates.......................

Level in English : read ?.................written ?...................spoken. ?..............Understanding of a conversation ? .........

If you have any result from an international test, please give us your score ?................................

International experience :

Have you already done an academic mobility or internship abroad?............................

If yes, where/what/when/how long? .......................................................................................................................................

Internship experience :

Have you already done an internship in a company?............................

If yes, where/what/when/how long? .......................................................................................................................................

OTHER DETAILS

Fathers job : ................................................................................

Mothers job : ............................................................

High level sportsman: NO YES

If yes, which sport?

What are your main hobbies ?.......................................................................................................................

Do you have a disability that requires a specific fitting from ENISE? NO YES

SCHOLARSHIPS

ERASMUS+
BRAFITEC
ARFITEC
CMIRA
EIFFEL
Government grant : if so, Country :
Internship gratification

Other : ..............................................................

ACCOMODATION

DO YOU APPLY FOR A ROOM IN A STUDENTS HALL OF RESIDENCE ?

YES NO

IF YES :

DURATION OF STAY AT ACCOMMODATION (EXACT DATES):

FROM: // TO: //

ECOLE NATIONALE DINGENIEURS DE SAINT-ETIENNE

58, Rue Jean Parot 42023 Saint-Etienne cedex 2 FRANCE
Tl 33(0)4 77 43 84 84 - Fax 33 (0)4 77 43 84 99 www.enise.fr
 Ne pas remplir Rserv ladministration

Do not fill - Administration only

COUVERTURE SOCIALE DE LETUDIANT ASSURANCE

Scurit Sociale Etudiant

Scurit Sociale non Etudiant : Asssurance volontaire (+ de 28 ans).............. Autre............................................

Centre payeur : SMERRA LMDE Autre............................................................................

Assurance responsabilit civile : Compagnie : ........................................................................................................

Frais de scolarit :

Frais dinscription ENISE

Scurit Sociale Etudiant
Contrle Mdical
Montant : ................................

Etudiant en change................................... Etudiant Erasmus

Scurit Sociale tudiant :

Paye par ltudiant

Paye par un tiers : .......................................
Exonr (Etudiant Erasmus Carte europenne)

ECOLE NATIONALE DINGENIEURS DE SAINT-ETIENNE

58, Rue Jean Parot 42023 Saint-Etienne cedex 2 FRANCE
Tl 33(0)4 77 43 84 84 - Fax 33 (0)4 77 43 84 99 www.enise.fr
 Documents to be submitted by the student:

To register at ENISE, you will need to submit the following documents:

Before arrival:

Completed registration form + recent photo ID

Medical certificate of aptitude to participate in practical work and sports activities. (Issued by your
doctor)
Photocopy of your vaccination record
Proof of your level of education: diplomas, transcripts of record
Proof of level of understanding of the French or English language
1 CV + 1 Letter of motivation

+ For students who are European nationals:

Photocopy of passport or identity card

Photocopy of the European Health Card

+ For students who are NON-European nationals:

Valid passport with visa

Birth certificate or family book
A translation of the birth certificate by a certified translator
Proof of resources (the minimum amount of financial resources required by the Prefecture is set
at 650 per month / 10 months).
MANDATORY: private insurance covering the student (health, repatriation) during the whole
time of his mobility in France (travel included)

During your first appointment at the ENISE:

Completed and signed supporting documents

Certificate of liability insurance
RIB (Bank Identity Statement) of a bank domiciled in France
Acceptance of ENISE rules

Fees to pay upon arrival at the ENISE:

Payment of all fees for students outside ENISE partnerships ( 830.10 in 2015/2016)
Partial payment (Social Security + medical control ie 220,10 in 2015/2016) for students
from partner universities
Partial exemption (payment of medical examination, ie 5.10 in 2015/2016) for European
students

+ Expenses related to education at the ENISE:

To be precised depending on courses program and/or internship :

Safety shoes
Blouse for practical work
Indicative price : 32 in 2016/2017 through the BDE (ENISE student office)

ECOLE NATIONALE DINGENIEURS DE SAINT-ETIENNE

58, Rue Jean Parot 42023 Saint-Etienne cedex 2 FRANCE
Tl 33(0)4 77 43 84 84 - Fax 33 (0)4 77 43 84 99 www.enise.fr