Exchange Student Application form 2015 / 2016 Please fill out this form in clear writing and send it by post, or by email to [email protected] Semester you wish to apply for: ¡ Autumn semester 200… ¡ Spring semester 200… (mid September – End of January) (mid February – mid June) Application deadline for the autumn semester is May 15 and for the spring semester November 15. Design group you wish to apply for (Brand / Industrial Product / Global Design): ………………………………………………………………………………………………….. ………………………………………………………………………………………………….. Details about your home school / institution Name of School / Institution…………………………………………………………………. ………………………………………………………………………………………………….. Name of Exchange Coordinator.................................................................................... E-mail address of contact person…………………………………………………………… Personal Details Last name……………………………………………………………………………………… First name……………………………………………………………………………………… Date of birth (yyyy/mm/dd)…………………………………………………………………… Address………………………………………………………………………..……………… …………………………………………………………………………………........................ ....................................................................................................................................... City and postal code………………………………………………………………………….. Country…………………………………………………………………………………………. Telephone……………………………………………………………………………………… E-mail address (please write clearly) ………………………………………………………………………………………………….. Which department / study program are you enrolled in?…….…………………………… Year of study at the school / institution you are currently enrolled in…………………… National credits/ECTS received so far……………………………………………………… Language skills Native language:……………………………………………………………………………… Language Skills: please assess your language level as accurately as possible using the online europass self evaluation grid at the link below: http://europass.cedefop.europa.eu/LanguageSelfAssessmentGrid/en English A1 ¡ A2 ¡ B1 ¡ B2 ¡ C1 ¡ C2 ¡ French A1 ¡ A2 ¡ B1 ¡ B2 ¡ C1 ¡ C2 ¡ Please provide copies of any language certificates Signatures Signed by Exchange Co-ordinator / Head of Department or other person at your school / institution. I confirm that this student has been nominated, and is a suitable candidate to undertake exchange placement at LʼÉcole de Design Nantes Atlantique. Date: ………………………… Signature Signature of student L’École de design Nantes Atlantique Atlanpole, La Chantrerie – Rue Christian Pauc - BP 30607 – 44306 Nantes Cedex 3 - FRANCE