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French American Culinary and Hotel Institute Inc. The European and American Connection
July 2011 – June 2012 Admissions Form
Licence Professionnelle de Restauration Gastronomique à vocation Internationale «Parcours culture gastronomique Française et Européenne»
Professional Bachelor´s Degree in International Gastronomic Restaurant Management «With an emphasis in French & European Culinary Culture» Program Starting Date: In wish to enroll for the program in France starting July
for one year.
Personal Information: Last Name __________________________ Mothers Maiden Name ______________________________ First Name _____________________________ Middle Name _______________
____
Date of Birth __________________________ Place of Birth (City and Country): _______________________ Citizenship _______________________________ Marital Status ________________________________
Permanent Address (parents): ________________________________________________________________
City: ___________________________State: _____________Postal Code: ________________________ Country: ________________________Home phone number : ( Cell phone number:
(
)
)
Email address:
Alternate email addresses: Facebook name:
. other social Media:
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July 2011 – June 2012 Admissions Form
Current Address (if different from page one): ___________________________________________________ City: ___________________________State: _____________ Postal Code: ________________________ Country: _______________________ Home phone number : ( Cell phone number: (
)___________________
)
__
Family Information: Father’s Name: Field of Work / Profession: Company Name: Address (if different from page one or above): ____________________________________________ City: _______________________State: ____________________Postal Code: ______________________ Country: ________________________Home phone number : ( Cell phone number: (
)
)
Mother´s Name:
Field of Work / Profession: Company Name: Address (if different from page one or above): ____________________________________________
City: _______________________State: ____________________Postal Code: ______________________ Country: ________________________Home phone number: ( Cell phone number:(
)
___
)
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July 2011 – June 2012 Admissions Form
Is one of your relatives a graduate of a EuroAmerica Program? (Mark with an X) Father
Mother Husband /Wife Sibling (Brother /Sister) Other
If selected other, Please specify:
Required Documents Enclosed:
Reserved for
EuroAmerica
OK
Verified
( ) Completed Admissions Form
( )
( )
( ) Letter of Motivation
( )
( )
( ) Birth Certificate
( )
( )
( ) High School Diploma or Equivalent
( )
( )
( ) College / University Degree completion documentation
( )
( )
( ) 6 passport color photographs
( )
( )
( ) Letters of recommendation
( )
( )
( ) Curriculum Vitae
( )
( )
( ) Medical Certificate of good health
( )
( )
( ) Waiver of liability form signed
( )
( )
( ) Proof of Medical Insurance
( )
( )
√
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July 2011 – June 2012 Admissions Form Educational Information: Please include all schools, universities, colleges and other training & educational programs
School / Place
Junior High School
High School
College / University
College / University
Professional / Other
Professional / Other
Dates
Diploma, Degree or Certificate Obtained
Date of Grad.
Primary Language employed
Primary Language employed
Other Language employed
From: To: From: To: From: To: From: To: From: To: From: To:
Professional Work Experience: Company Name
High School
College / University
College / University
Professional / Other
Professional / Other
Dates
From: To: From: To: From: To: From: To: From: To:
Job Description / Title
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July 2011 – June 2012 Admissions Form Languages: Spoken: Basic
Intermediate
Advanced
Mastery
√
√
√
√
( ) English
( )
( )
( )
( )
( ) French
( )
( )
( )
( )
( ) Spanish
( )
( )
( )
( )
( ) Italian
( )
( )
( )
( )
( ) German
( )
( )
( )
( )
( ) Other, please specify: _________________
( )
( )
( )
( )
( ) Other, please specify: _________________
( )
( )
( )
( )
√
Motivational Information:
Please feel free to answer the following sections on a separate piece of paper if necessary. What makes you want to study the hotel, food & beverage and culinary fields?
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July 2011 – June 2012 Admissions Form
Motivational Information: Why would you like to study in France and how will you benefit from it?
What is making you choose French American, The UniversitĂŠ de Cergy-Pontoise and the IUFM?
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July 2011 – June 2012 Admissions Form
How did you find out about French American and this program?
How could total immersion in French for one year be beneficial for you?
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July 2011 – June 2012 Admissions Form
How could you benefit from being exposed to French and European culture?
How could this experience positively impact your professional career, your hometown, your region, your country and the world in general in the future?
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July 2011 – June 2012 Admissions Form
Print name:
Date:
Signature: ________________________________________
All legal documents from the United States of America submitted must be notarized copies. In the case of documents originating in other countries, all documentation must be Apostille by the issuing country. College transcripts must be sealed and must come directly from the issuing college or university. The Université de Cergy-Pontoise is authorized to deliver the “diplôme de licence professionnelle de restauration gastronomique à vocation Internationale” accredited by the “Ministère Français de l’Enseignement Supérieur et de la Recherche” (French Ministry of Higher Education and Research) and is therefore official in Europe and is recognized in many countries around the world. Please send all Documentation to: French American Culinary and Hotel Institute Inc. 4370 La Jolla Village Drive Suite 400 San Diego, CA 92122 Tel. (858) 546-4332 Fax (858) 546 4334 www.frenchamericaninstitute.org info@frenchamericaninstitute.org Muriel Schiffmann International Program Director m.schiffmann@frenchamericaninstitute.org
*** You will be notified within 2 to 4 weeks of admission into the program via email and via regular mail. If you have not received any notification after 6 weeks of submission or after the 31st of May 2011, please contact us at the address above or call us at (858) 546-4332.