STUDENT APPLICATION FORM Photo

EXCHANGE PROGRAM

ACADEMIC YEAR 2022/2023

Exchange program
 Erasmus  Bilateral agreement

Duration of mobility :
 one semester  one year

Programs taught in French:

 Computer science engineering (taught in French)

 Mathematics/Computer engineering (taught in French)
 Financial engineering (taught in French)

Programs taught in English:

 Bachelor Data Science by Design year 1 Fall Semester

 Bachelor Data Science by Design year 1 Spring Semester
 Bachelor Data Science by Design year 4 Fall Semester

Semester
 Big Data – Master 2 Fall Semester
 Big Data – Master 2 Spring Semester

SENDING INSTITUTION

Name and full address:

Kalinga Institute of Industrial Technology (KIIT)
Patia, Bhubaneswar, Odisha, India 751024
+910674 2725113 ; kiit@kiit.ac.in
................................................................................................................

Institutional coordinator:
Name: Md. Abdullah Al Riaj
Phone number: +8801710697146 ; +918167734247
E-mail: riaz.vc@gmail.com

STUDENT’S PERSONAL DATA

Family name: Riaj

First name: Md. Abdullah Al

Sex: F M

Birthdate (dd/mm/yyyy): 24/12/1998

Place of birth : Old Satkhira, Satkhira, Bangladesh - 9400

Nationality: Bangladeshi

Current address : Permanent Address :

KP 8A, Campus 11, KIIT University Old Satkhira, Satkhira Sadar,
Patia, bhubaneswar, Odisha 751024 Satkhira - 9400 , Khulna
India Bangladesh
Phone number: +8801710697146 ; +918167734247
E mail : riaz.vc@gmail.com

LANGUAGE COMPETENCE

Mother tongue: Bengali

Language of instruction at home institution (if different): English

English Medium
Level in English
A1  A2  B1  B2  C1  C2

LEVEL IN FRENCH LANGUAGE

I’m currently studying French language:

 Yes  no

If yes, what is your level :

A1  A2  B1  B2  C1  C2
Are you able to follow courses in French?
 Yes  no

ACCOMMODATION

The International Relations Office can book accommodation for all international
students. Please contact us as soon as possible: Vanessa MEGUELLATI
vanessa.meguellati@cyu.fr

This application form has to be fulfilled by the student, validated by the sending
institution and sent to EISTI with documents required.
Before May 31st for the Fall Semester or for the year
and before October 31st for the Spring Semester.

Required documents:
- Copy of identity card/passport
- Copies of official transcripts of grades and degrees at Bachelor and Master
level
- Recent picture to stick on this application form
- Cover letter
- Resume
- Proof of English language level

For further information, feel free to contact us: international@cy-tech.fr

For European, Erasmus partners and Russia, please contact Audrey JAMA
Audrey.jama@cyu.fr
For non-European partners, please contact Vanessa MEGUELLATI
vanessa.meguellati@cyu.fr

Date : 15/12/2022 Date : ……/………/………

Student’s signature: STAMP SENDING INSTITUTION:

Institutional Coordinator’s signature :