application for mobility grant 2010/2011 - Portail de la scolarité ...

Direction des Etudes et de la Scolarité
Accueil administratif – aide sociale – logement – Aide sociale
NOTICE
(Please retain this document)
APPLICATION FOR MOBILITY GRANT
2010/2011
To ensure your application is examined under the best possible conditions, it must be carefully completed and forwarded to the
service des bourses, 9 rue de la Chaise 75337 Paris cedex 07, accompanied by all the documents listed, no later than 12
midday on Wednesday 3 February 2010 for study abroad programmes. For internships, the cut-off date is 12 midday on
Wednesday 5 May 2010.
We draw your attention to the fact that if the information or documents requested are not supplied, no reminder will be issued to
the student concerned and no further action will be taken; neither will any further action be taken for applications handed in after
the cut-off date.
Reminder: No payment can be made if you have not completed your 2009-2010 administrative registration.
Documents that must be enclosed with your application
• For all students:
o For French students: photocopy of the tax assessment for both parents (2008)
o For European and non-European students: you must enclose a French translation of the documents supplied, with the
figures converted into euros
o A letter setting out your situation and supporting your request for financial assistance
o A copy of the internship contract corresponding to the period abroad and an attestation mentioning any remuneration to be
paid by the host entity
o A R.I.B (bank account details) from a French bank in the student's name
• For students in receipt of a CROUS bursary on social criteria:
o As well as the 2008 tax assessment: a copy of the CROUS 2009-2010 notification (if not already forwarded to the bursaries
service).
• For students whose family situation has changed since 2008:
The cases most frequently encountered are listed below:
Retirement of a parent
Unemployment of a parent
Illness of a parent
Divorce of parents
Death of a parent
DOCUMENTS TO BE PRODUCED
Document indicating the amount of the basic and supplementary pension.
Document indicating the amount of unemployment benefit paid:
notification of the decision + last 3 payment slips.
Document indicating the amount of benefits paid (social security or private
insurance).
Decree of divorce indicating the amount of maintenance payments; if no
maintenance is paid, please supply tax assessments for both parents.
Death certificate, survivor's pension (if already in place).
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FORM
Please return with the documents requested
APPLICATION FOR MOBILITY GRANT - 2010-2011 ACADEMIC YEAR
Destination: …………………………………..….
Town: ……………………………………………….
Country: ………………………………………………
Type of training: [__| Study abroad
[__| Internship Remuneration to be paid = yes - no Amount =
Reminder = enclose attestation of internship
Duration of study period / internship: from .…../…../ 2010 to ..…./…../ 2011
• INFORMATION CONCERNING THE APPLICANT:
[__| Miss [__| Mrs [__| Mr
FAMILY NAME: .............................................................................. FIRST NAME: ...............................................................
Date of birth: [___|___|___] Place of birth: ...........................................................................................................
Address: ....................................................................................................................................................................................................
E-mail ....................................................................................................... Tel.: ……………… ..................................................................
Nationality: French Other nationality: .................................................................................
Special case: Refugee resident in France
• IF THE APPLICANT IS MARRIED OR HAS ENTERED INTO A CIVIL SOLIDARITY PACT, INFORMATION ABOUT THE
SPOUSE/PARTNER:
MAIDEN NAME (if applicable): ........................................................................................ First name(s) ...................................................................
Date of marriage: [___|___|___]
Number of applicant's dependent children: ................................... [____]
Spouse/partner's profession:. ........................................................ Is the spouse/partner a bursary recipient yes no
• APPLICANT'S ACADEMIC TRAINING:
Baccalaureate or equivalent diploma (please specify) ................................................ Year obtained [___|___|___]
Academic year Discipline, year of programme and establishment Bursaries obtained and amount
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• APPLICANT'S FAMILY:
Father [__| Guardian [__| Mother [__| Guardian [__|
FAMILY NAME ................................................................................
(in capitals)
FAMILY NAME: ...............................................................................
(in capitals)
First name(s) ..........................................................................
Where applicable:
date of death, divorce, separation: [___|___|___]
(cross out whichever does not apply)
Profession: ............................................................................
Place of work: ………………..
Home address ..............................................................
..............................................................................................
Post code ……………… Tel...............................................
First name(s):.....................................................................
Where applicable:
date of death, divorce, separation: [___|___|___]
(cross out whichever does not apply)
Profession : ............................................................................
Place of work: …………………
Home address: ..............................................................
..............................................................................................
Post code …………… Tel...................................................
• FAMILY EXPENSES TO BE TAKEN INTO CONSIDERATION:
Family name and first name of each
dependent sibling
(not including yourself)
Date of
birth
University to be attended
in 2010-2011
Class or year of
programme in 2010-
2011
Expenses
Student
Distance between parents' domicile and Sciences Po – Paris campus
Less than 30 km
30 to 249 km
250 km or more
Family
Number of siblings (other than student - as per 2008 tax assessment)
- siblings enrolled in higher education in 2010-2011
Resources (in euros)
"Revenu Brut Global" or "Déficit Brut Global" line in 2008 tax assessment
Family quotient (total gross income / number of tax units ("parts")
For administrative use
Total expense points (points de charge)
CROUS level (échelon)
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If you do not have a French tax assessment, declaration of income in 2008
Enclose a photocopy of the declaration of income (translated into French), underlining "total gross income"
Currency (if not in euros): ………………………………1
Nature of income
Annual income of father (salary, professional fees, etc.)
Annual income of mother (salary, professional fees, etc.)
Pensions (maintenance payments, retirement pension)
Unemployment or sickness benefits
Land and/or farm income
Income from property and/or capital assets
Income from industrial and/or trading activities
Other(s)
Tax paid if deducted at source
Amount in euros
………………………………
………………………………
………………………………
………………………………
………………………………
………………………………
………………………………
………………………………
………………………………
Have you applied for any other mobility grant for 2010-2011
yes [__| no [__|
Type and name of grant: ………………………………………………………………………………………………
Amount: ………………………………………………………..
Accepted: yes [__| no [__|
Awaiting decision: yes [__| no [__|
I, the undersigned: ………………………………………………………………………………………………………………………………
hereby attest that the information given is accurate and that any erroneous information could lead to withdrawal of the
grant awarded by Sciences Po and exclusion from the establishment:
Signed in ……………………………………………………
on ………………………………………………………
Applicant's signature
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2009/10/30
ACCOMMODATION information – Undergraduate
programme -
(Confidential document to be retained by the Sciences Po Paris accommodation service)
The Sciences Po accommodation service is keen to establish a partnership with the owners/landlords of
accommodation used by its students. Please provide the following details concerning your current
accommodation.
Family name: .................................................................... First name:
....................................................
Current accommodation:
Housed by family or free of charge
Tenant in university campus/residence (public or private)
Tenant: shared apartment/house sole tenant
room rented in private home
Current address: ………………………………………………………………………………
.......................................................................................................................................................
Post code: …………………………
Town: ……………………………….
During your year abroad
I am planning to keep my current accommodation: yes no
I am planning to leave my current accommodation: yes no
Date of end of rental agreement:…………………………………………
I would like to recover this accommodation on returning to Sciences Po:
no
yes
Contact details of owner/landlord
Please note the contact details of the owner/landlord (or of your family if it wishes to offer
accommodation to a foreign student during your absence) to allow the Sciences Po accommodation
service to contact them:
Family name: …………………………………………………….
Address: ……………………………………………………………………………………………
Tel.: ………………………………………………………………………………………………...
E-mail: ……………………………………………………………………………………………...
Sciences Po / DES / Pôle Logement 1/1

2009/10/30
Thank you for your assistance!
Sciences Po / DES / Pôle Logement 1/1