EPHEC International - Registration

Personal information

Last name

First name

Gender

Date of birth (dd/mm/yyyy)

Place of birth

Mobile phone

Studies in home institution

Détails

Specific needs/disabilities. Do you have special needs ?
If you answered « yes », then we will contact you soon for further information.

Yes

Private address

Street, N°

Zip code

Town

Country

Person of contact in case of emergency & link with student (mother, etc)

Mobile phone of the person of contact (please mention country/area code and phone number)

Information concerning home institution

Country of home institution

Home institution

Name of home coordinator

Phone of home coordinator

Email of home coordinator

Duration of stay

Level of English (Please indicate your level CECR or IELTS)

Required level of English: CECR B2 & IELTS 5.5
Required level of French (for the regular courses): CECR B2

I would like to follow