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.
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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)
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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)
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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 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
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