International Students Application Form

International Students Application Form
Personal Data

First name*

Last name*

Birth date

Gender *

Citizenship

Issue Date

Expiration Date

Email

Address

City

Country

Zip Code

Phone (country code)-(city code)-(number)

Academic Data

Country where you completed your secondary studies

Home University

Study Program at Home University

Number of Semesters completed at Home University

Name of International Coordinator at Home University

International Coordinator's Email

Campus selected

In which language will you take courses?

Semester(s) applying

Year applying:

Language proficiency

English

French

Question

Contact Person in Case of Emergency

Name and Surname/ Family name

Relationship

City

Country

Zip Code

Phone (country code)-(city code)-(number)

Email

Do you suffer from any condition that could require medical assistance while you stay in Benin?

Please specify:

Do you take any medicine in a permanent way? *

Please specify: *

Documents to Attach
Please upload the following documents

Nomination letter from home university

Academic record *

Photocopy of passport (first page) *

1 ID size photo (JPEG format) *