ISM ABROAD

PROGRAMS
Application Form For
Outbound Students

Academic Year 20.... / 20....

 APPLICATION FORM FOR OUTGOING A.Y. 2021-2022

Photo

I. Applicant’s Personal Data

Title : Mr Mrs Miss

First / Given name(s) :
Family name/ Surname :

Gender : Female Male Date of birth :

(day/month/year)

Nationality : Passport N0 :

What program are you applying for?

Double Degree
Exchange Program
International Admission
Current Level Bachelor 2 / 3 or Masters M1/M2 Level/Semester and Principal Subject or Course at ISM

What semester would you like to join?

FALL (September)
SPRING (January)

Your email address :

Your phone number :
Name of parent or Guarantor :
Email of Parent or Guarantor :
Mobile/Cell of Parent or Guarantor :

II. Language Skills

English Excellent Good Basic
Spanish Excellent Good Basic
Korean Excellent Good Basic
Japenese Excellent Good Basic

If you have ever taken a

TOEFL IELTS TOEIC BELT
Date Date Date Date
Score Score Score Score

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 APPLICATION FORM FOR A.Y 2021-2022

III. Choice of Business School/University & Programs

Indicate the schools or universities you would like to join (order of preference)

1st Choice

2nd Choice

3rd Choice

IV. The Motivation

Why are you interested in this mobility program, and what practical use would you make of its outcomes? (10 lines)

V. Declaration
I hereby certify that all the information provided in this application is accurate, and as an exchange program student,
I shall return to Groupe ISM in Senegal after the completion of my studies abroad.

Signature of the Name, Contact and Signature of Academic Director Signature

date
Applicant Candidate’s Parent or Guarantor & Stamp (Dir. Prog. ISM)

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