First Name :
Last Name :
Date of birth :
University or College :
Partnership with :
Ecole Nationale supérieure de Chimie de Montpellier (ENSCM)
L’Institut Agro - Montpellier SupAgro
Years of Undergraduate Studies:
Please select courses from the following menu :
FLOW MAIN TOPICS
Select up to 3 main topics, and assign it/them a preference number from 1 to 3
(1 being your preferred choice)
• Food, Living Organisms, Water
• Sustainable Energy and Materials
• Data and Information processing
Please upload the following documents : (max file size : 5Mo / supported files : .doc, .docx, .jpg, .jpeg, .pdf)
Short resume :
Cover letter :
Transcripts of records for the past two years :
ACKNOWLEDGMENT & SIGNATURE
Enrollment in the Polytech FLOW Summer School Program is contingent upon meeting all course prerequisites, completing enrollment and registration procedures and requirements, and fulfilling any other applicable requirements; and is subject to space availability in your selected courses.
No person shall be denied admission to the Polytech FLOW Summer School Program on the basis of any legally prohibited discrimination involving, but not limited to, such factors as race, color, creed, religion, national or ethnic origin, marital status, citizenship, sex, sexual orientation, gender identity or expression, age, disability, or protected veteran status.
However, Polytech Montpellier reserves the right to deny admission to any applicant, to discontinue the enrollment of any student whose personal actions are detrimental to the University of Montpellier (UM) community or are in violation of any applicable code of conduct, regulation or law, and to require the withdrawal of a student whose continuance at the UM would be detrimental to himself or herself or to others. It is the responsibility of students to become familiar with UM and Polytech Montpellier regulations and procedures relating to their courses of study, and with the French laws governing their stay in France.
By submitting this form, I agree that the information I entered may be used within the framework of Polytech FLOW. I understand that I have a right to access, rectify, cancel and oppose the use of my personal data, by contacting
I, the undersigned, declare that I have read and accept the above terms.