Please fill out this form electronically and send

your documents per email to:

APPLICATION FORM FOR ADMISSION
SPRING SEMESTER IN NUTRITIONAL
incoming@unilasalle.fr
SCIENCES
For your information: ACADEMIC YEAR: 2018/2019
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
photo
60026 BEAUVAIS Cedex – FRANCE
http://international.lasalle-beauvais.fr/-Study-at-LaSalle-
Beauvais-

Application deadline: October 15th

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:

Married Single Children: yes no

Father’s job:

Mother’s job:
Current personal address: Cellphone:

Street & number: ………………………………………………………………………………………………

City: ……………………………………………………………….… Postal code: ………………………...

Country: ………………………………………………..
E-Mail (personal):

Person to contact in home country in case of emergency (name, telephone number and e-mail address): 

Home university: (full name and full postal address) Erasmus+ code
for European Universities

Faculty / College: ………………………………….

Contact person at home university: (name, tel., fax, 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)

Type of Exchange Program:

Erasmus+ Other (specify): ……………………………………………….

Bilateral institutional exchange

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Application form UniLaSalle
Grant:

Do you receive a grant? Yes No If yes, specify: .................................................................

Distribution rights of your personal data to:

- Alumni association: Yes No

- Marketing and Communication Department: Yes No

- Student organization (AGE): Yes No

Specific needs

During this program you may be in contact with different type of food
Do you have dietary restrictions for cultural or religious reasons:
Yes No If yes, what is it? …………………………………………………………………………………

We are committed to provide support services and reasonable academic accommodations to students with
documented disabilities and those disabled by chronic conditions. Our student disability coordinator Xavier
Quernin (xavier.quernin@unilasalle.fr), will be happy to work with students to identify appropriate
accommodations. We recommend you contact us as early as possible and in any case before your arrival on
campus; we want to make sure your needs are met in time for classes.

Academic background
Last degree obtained (name, year, level and location):

Current level / year / major-minor in your home university:

Have you already studied in France before?: Yes No

If yes:
- Where? (school name and town):
- What for? (level of study and/or name of degree/program):
- Dates? :
- Number INE (Identification National Etudiant) if you know it:
Knowledge of languages:

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Application form UniLaSalle
French Excellent Advanced Intermediate Basic (oral)

Excellent Advanced Intermediate Basic (written)

English
Excellent Advanced Intermediate Basic (oral)

Excellent Advanced Intermediate Basic (written)

Other ……………......

Excellent Advanced Intermediate Basic (oral)

Excellent Advanced Intermediate Basic (written)

Documents to be provided

Official copy of exam of:

* English language - 785 TOEIC level as a minimum (programs taught in English)

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

1 résumé (Curriculum Vitae) + 1 cover letter

1 photo – ID format for your future student card

1 passport copy with photo

1 birth certificate translated in French (except EU students)

Learning Agreement - Duly completed (list of all selected courses and associated ECTS credits) &
signed by your home coordinator and yourself

After acceptance only:

Accommodation application form – Please take note of all information written on that form

Proof of Health Insurance coverage

 1 birth certificate translated in French by a French sworn translator officially
recognized by the French administration or a French consulate or embassy (except EU
students) required for the registration to the French health insurance

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

Recap of the fees you have to pay upon arrival

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Application form UniLaSalle
 Campus fee: 100€
 Room insurance and liability insurance: 39€
 AGE (Student General Association) to participate to the campus life: 15€
 Health insurance (for non-European student): +/- 100€ (to be confirmed)
 Field-trip (if you have chosen it during the Spring semester): 350€

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Application form UniLaSalle