Application Form for the EXCHANGE Scholarship

Passport size
photo

Please read the guidelines for application before filling the form!
Incomplete files will not be considered.
Type your information above the black line with font size 12
Bachelors or Masters degree students, enrolled in an Indian institution that has an exchange agreement with a
French institution are eligible. Scholarship will be granted for one academic semester (upto 4 months).

Do not alter layout of pages when completing the form

Your personal details
Surname

First name(s)

Previous surname (if married)

Date of Birth (dd / mm / yyyy)

Gender

Place of Birth

Nationality

Highest academic degree obtained

Your current field of study

Current Degree undertaken/ pursuing

Specialisation subject

Start and End date of the program (dd/mm/yy-dd/mm/yy)

Number of Months

Contact details of your HOD / professor in charge in India

Name and Surname
University / Institution and Department
Designation

E-mail

Tel.

Mobile.

Tel

Your current address

Street, P.O. Box
Postal code
Country

City/town
E-mail

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Your contact person and host institution in France

First Name and Surname
University/Institution
Department/Institute
Street/P.O. Box
Postal code

City

E-mail

Tel.

Your application status

Do you have a confirmation of your admission in the French institution?
Confirmed

Awaited

Your other application(s)

Are you applying for a scholarship to any other institution?
Yes

No

If Yes, which one?

Have you previously been awarded a French Embassy Scholarship or French Government Scholarship?
Yes

No

Year

Your stay in France

Have you ever been to France?
Yes

No

If Yes, for which purpose (study, tourism, etc)?

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Your Curriculum Vitae

XIIth & University examinations / degrees

Period
(mm. yyyy)

Name of University/Institution

City

Degree

Specialisation

Percentage / CGPA

Academic / Employment record (for the last 2-3 years)

Period
(mm.yyyy)

Internships / Projects

Organisation

Position

Previous and /or present study and stays abroad for at least two months
Period
(mm.yyyy)

Institution

City, Country

Financed by

French language proficiency

None
DELF / DALF examination

A1

A2

B1

B2

C1

C2

If not DELF / DALF, please specify __________________________________________________________________________________________

(school / coaching classes / self-taught or any other)

Where did you hear about this scholarship?

Professor

Peer / Senior

Campus France

Alliance franaise

If other, please specify____________________________________________________________________________________________________

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Statement of Purpose (Times New Roman - 12)

Please provide your responses to the below questions.
Your responses to each question should not exceed 250 words.
You must ensure that your statement of purpose is a reflection of your own thoughts.

1. Explain how the Exchange Program would add value in your further studies or in launching
your career.

2. Explain why/how you chose the French institution to which you have applied or have been
admitted.

3. Explain why you would be a worthy candidate for the scholarship.

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I hereby declare that the above statements are true to my knowledge and belief; that I am of sound health and not physically handicapped in a
way that would prevent me from carrying out my project in France.
The French Embassy has my permission to electronically store my personal data, which is required for my scholarship application and my
possible stay in France. If a scholarship is awarded to me, my name and institution of origin may be included in lists published by the French
Embassy in India.
If I am awarded a Charpak scholarship of excellence, I agree to become a Charpak Ambassador of French higher education when I return to
India. This may involve taking part in one or two higher education events at the Alliance Franaise of my city, or in one or two events organized
by a Campus France counsellor in my Indian university/ institution of origin.

Place & Date

Signature

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