Application Form for the EXCHANGE Scholarship Passport size

Please read the guidelines for application before filling the form!
Incomplete files will not be considered. photo

 Type your information above the black line with font size 12
 Bachelor’s or Master’s degree students, enrolled in an Indian institution which has an
Exchange agreement with a French institution are eligible.
 This Scholarship will be granted for one academic semester (up to 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

Street,P.O. Box ________________ ____________

Mobile Tel.
Postal code
fsdf City/town
_________________________
e-mail
Country

Your current field of study in France

Degree/program undertaken/ pursuing in France Stream

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

Details of your institution in India

Full Name of your program

University / Institution and Department

Name, Designation of your Professor/HOD E-mail Tel.

Application Form Exchange Program -

1/5
Your host institution and contact person in France

University/Institution

Department/Institute

Name and designation of your contact person in France

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, specify?

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

Yes No Year

Your previous stay in France

Have you ever been to France?

Yes No

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

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)

Application Form Exchange Program -

2/5
Where did you hear about this scholarship?

Professor □ Peer / Senior □ Campus France □ Alliance française □

If other, please specify____________________________________________________________________________________________________

Your Curriculum Vitae

XIIth & University examinations / degrees

Period
Name of University/Institution City Degree Specialisation Percentage / CGPA
(mm. yyyy)

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

Period
Internships / Projects Organisation Position
(mm.yyyy)

Previous and /or present study and stays abroad (including France) for at least two month’s duration
Period
Institution City, Country Financed by
(mm.yyyy)

Application Form Exchange Program -

3/5
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.

Application Form Exchange Program -

4/5
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 Française 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

Application Form Exchange Program -

5/5