EBS PARIS 2017 SUMMER PROGRAM

APPLICATION FORM

Please complete all items in this form. Type or write legibly.

1. Personal Details

Last Name San Martin Gomez

First Name

Date of Birth (mm/dd/yyyy) Gender: Female Male

Country of Birth

Country of Citizenship
(if you have dual citizenship, state both)

Permanent Address

Email Address
(please list an email address you check
regularly)
Telephone Number
(including country & area codes)

2. Study Program
Doing Business in Europe - SUMMER PROGRAM :
Program you wish to enroll in - May Program (May 15 to June 9, 2017)
- July Program (July 3 to July 27, 2017)

3. Sending Institution

Sending Institutions Name

Sending Institutions Full

Address

International Coordinator's
Full Name
International Coordinator's
Email Address
Signature and Seal

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4. Emergency Contact

Last Name

First Name

Address

Email Address

Telephone Number(s)
(including country and area codes)

5. Miscellaneous
Please indicate any health /
medical conditions you think
we should be aware of (such as
allergies, etc.)

Authorization: If you wish to give a relative or personal friend authority to contact ebs Paris regarding your admission status, please print
that persons name here: ___________________________________ and sign here: _________________________________

Statement of Understanding. (Read and sign before submitting your application.)

I certify that the information given in this application is complete and accurate, and I understand that to make false or fraudulent statements
with regards to any information on this application or my lawful status in France may result in disciplinary action, denial of admission, and
invalidation of credits earned at ebs Paris. If accepted, I hereby agree to abide by the rules and regulations of ebs Paris. Should any of the
information I have given change prior to my arrival in France, I shall immediately notify ebs Paris. I understand that acceptance as an
exchange student does not guarantee later admission as a degree-seeking student. Accordingly, I hereby authorize the release of my ebs
transcripts to ebs exchange officials and I authorize ebs to send my transcripts and information on my ebs courses, credits, and grades to
the Registrar or Official Program Designee at my home institution at the end of each term.

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Applicants signature Date

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 APPLICATION DEADLINES & CONTACT INFORMATION

DEADLINES

May Program - Application : March 31, 2017

July Program - Application : May 15, 2017

CHECKLIST

Application Form filled out completely and signed

Copy of transcript

Photo (passport size)

Proof of appropriate health insurance

Copy of passport

CONTACT AT EBS PARIS:

INTERNATIONAL RELATIONS DEPARTMENT

Katy Ferreira Sara Plaisant

Summer Program Coordinator Head of International Relations Office
ebs Paris ebs Paris
10 rue Sextius Michel 10 rue Sextius Michel
75015 Paris 75015 Paris
France France

Tel.: +33 1 40 71 37 31 Tel.: +33 1 40 71 37 10

Email: katy.ferreira@ebs-paris.com Email: sara.plaisant@ebs-paris.com

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