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1 Application Form - Academic Year 2017-2018
Application Form Academic Year 2017-2018
Please fill in this form in black ink and in block letters as carefully as possible.
Submit this form along with therequired supporting documents:
June 30th for visa-seeking students
CHOICE OF PROGRAMME (PLEASE TICK THE BOX):
MSc in International Business Development (MSc IBD)
MSc in Arts and Cultural Management (MSc ACM)
MSc Corporate Finance & Investment Banking (MSc
CFIB)
MSc in Global Marketing & Negotiation (MSc GMN)
PERSONAL DETAILS
Family Name: ...........................................................................................................................................................................................
First Name: ...............................................................................................................................................................................................
1st Nationality: ....................................................................................... 2nd Nationality: ..........................................................................
Gender: M F
Date of birth (dd/mm/yyyy): ............................................................... Place of birth: ............................................................................
Professional Status: ...................................................................................................................................................................................
Residential Address: ..................................................................................................................................................................................
Postal code (if applicable): ................................................................... City: ...........................................................................................
Country: ....................................................................................................................................................................................................
Postal Address (if different from the residential address): ......................................................................................................................
..................................................................................................................................................................................................................
Postal code (if applicable): ................................................................... City: ..........................................................................................
Country: ...................................................................................................................................................................................................
Home Phone Number: (country code) ................................................. (Number): .................................................................................
Cell Phone: (country code).................................................................... (Number): .................................................................................
Preferred E-mail Address: ........................................................................................................................................................................
Skype ID (mandatory for interview): ........................................................................................................................................................
Official use only:
Programme: IBD GE CFIB GMN ACM
Student number: ...............................................................................................................................................................................
Mode of recruitment and contacts: ..................................................................................................................................................
Final decision: ...................................................................................................................................................................................
Application received on: ...................................................................................................................................................................
Application fees: ...............................................................................................................................................................................
Affix Photograph
here
2 Application Form - Academic Year 2017-2018
ACADEMIC BACKGROUND
University Education
Name of University Degree obtained Major/Specialisation Mark/Grade Start year End year
Secondary Education
Parallel Courses/ Certificates
Please detail: .............................................................................................................................................................................................
...................................................................................................................................................................................................................
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Languages
First language (mother tongue): ...............................................................................................................................................................
Language of tertiary education (if different from above):.........................................................................................................................
English test (if any):
Test IELTS TOEIC TOEFL
Score
Date
Other languages ....................................................................................................................................................................................................................
Language Read Written Spoken
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
Please mark the correct box (1: fluent / 2: very good / 3: average / 4: poor)
Name of School Diploma
3 Application Form - Academic Year 2017-2018
Cultural experience
Have you ever studied abroad? Yes No
If yes, where and when?
...................................................................................................................................................................................................................
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Describe a multicultural experience that has influenced you in particular. Explain why (The experience does not have to have taken
place abroad. It could be a multicultural experience in your own country).
...................................................................................................................................................................................................................
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Experiences (employment/ internship/ volunteer activities)
Organisation Function Tasks assigned to you Period
Please comment on your most important life experience (work, social activities, students organisations, extra-curricular projects...).
How has it had an influence on your life?
...................................................................................................................................................................................................................
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Motivation for the programme:
Why Burgundy School of Business?
...................................................................................................................................................................................................................
...................................................................................................................................................................................................................
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Why this programme?
...................................................................................................................................................................................................................
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Your professional project?
...................................................................................................................................................................................................................
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4 Application Form - Academic Year 2017-2018
PERSONAL QUESTIONS
If you are admitted to the programme, how will you finance your studies?
Self-Sponsored..................................................................... Grant
Bank Loan in home country Company Sponsorship
Others: .................................................................................................................................................................................................
In case of non-admission, what alternative have you foreseen? What other programmes do you intend to apply for?
...................................................................................................................................................................................................................
...................................................................................................................................................................................................................
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How did you hear about this programme ?
Search Engine:
Google.com Ask.com
Yahoo.com Other:...............................................................................................
Website:
Masterstudies.com studyportal.eu/ mastersportal.eu
Education Fair:
Name of the fair: ......................................................................................................................................................................................
Advertisement: .........................................................................................................................................................................................
French government Agency:
Alliance Française Institut Français
Consulate CampusFrance
University - Name: ...............................................................................................................................................................................
Personal or professional contacts: .......................................................................................................................................................
Declaration
I affirm that I have been informed of the cost of tuition fees for the ................................................................... programme, as well as
the average cost of living associated with studying in Dijon, France and that I am able to meet these expenses. I certify that the
information I have entered in this form is complete and accurate to the best of my knowledge and that the accompanying documents
are true. I understand that misrepresentation of any of the information submitted may lead to the cancellation of my application
and/ or registration, with no refund of any of the fees possible.
Date:
Signature:
5 Application Form - Academic Year 2017-2018
Please check you have enclosed the following documents:
Completed application form
Statement of goals for your studies at Burgundy School of Business
Curriculum Vitae/resume
Official academic records of courses attended with marks (in English or French)
Certified copy of your Bachelor’s degree translated into French or English (for students enrolled in their last year, a certificate of
enrollment will be required)
Recommendation form
TOEIC, TOEFL or IELTS certificate for non-native speakers of English
Copy of passport/identity card, and residence permit if applicable
Payment of € 100 application fee
APPLICATION FEE (€ 100)
Please indicate which method of payment you have chosen.
I will pay the application fees of € 100 by cheque. The cheque will be made to «Groupe ESC Dijon» I
will transfer the amount of € 100 to the bank account of Groupe ESC Dijon:
Account Holder’s name
ESC Dijon-Bourgogne
Account Holder’s address 29 rue Sambin – BP 50608
21006 DIJON Cedex FRANCE
Name of bank
BP BOURGOGNE FRANCHE-COMTE
Address of bank BPBFC DIJON TREMOUILLE
14 Boulevard de la Trémouille - 21000 Dijon
BIC/SWIFT
CCBPFRPPDJN
IBAN
FR76 1080 7004 0172 3213 7072 772
APPLICATION FORM SUBMISSION:
Please send this application form, marked for the attention of Ms Bérengère MOINDROT to the following address:
BSB - Burgundy School of Business
29 Rue Sambin-BP 50608 21006
DIJON Cedex France
Or send it as an e-mail attachment to: berengere.moindrot@bsb-education.com
IMPORTANT!
Your last name & the name of your programme (Msc ACM / MSc CFIB / Msc IBD / MSc GMN)
should be given as reference for the bank transfer.
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