Online registration academic year

Title

Madam, Miss Mister

First name

Last name

Picture

Date of birth

Nationality

Civil status

Single

Married

Other

Place of origin

Actual address :

Street

Postcode

City

Country

Phone number

E-mail address

Date of arrival in Switzerland if already in the country

Parents or guarantor :

First and last name

Street address

Postcode

City

Country

Academic situation in Lausanne :

Already registered

Yes No

If yes, indicate the date and registration number

Student mobility, university exchange

Yes

No

Institution

University of Lausanne (UNIL)

Swiss Federal Institute of Technology in Lausanne (EPFL)

Other Highschool

Faculty, section Specify the faculty, department you've registered

Level of study Precise the level of study, for ex. B1-2-3, M1-2

Monthly financial ressources during studies in Lausanne :

Ressources

Family Scholarship Other income

Precisions Precise name of the person, institution or employer providing your financial support

Type of room registration :

I'm registrering for a one bed room :

CHF 639

CHF 719

depending of size

I'm registrering for a two beds room :

CHF 838

I'd like to share the room with a person also registered, named hereafter

First and last name of the person with whom I wish to share a double room :

Lease period required, with possibility to renew

Saturday August 6th 2022 to Saturday July 1st, 2023

Saturday August 27th 2022 to Saturday July 1st, 2023

Thursday September 1st, 2022 to Saturday July 1st, 2023

Planned duration of the stay at Planète Bleue Generally the stay is limited to 2 academic years

Planned date of arrival

Planète Bleue, an original house for students :

How did you know the existence of Planète Bleue?

After having read the charter and visited the website, what are your motivations and expectations to live in hte House?

Mention what you'd like to bring, organize in order to enrich the multicultural life in a shared accomodation

For non french-speaking students, evaluate your level in french :

A1 A2 B1 B2

Europass file

I do accept the charter and House rules

Yes

Place Indicate your current place for signature

Date