Last/Family Name: *
First name: *
Date of birth: *
Format DD/MM/YYYY
Nationality/Citizenship: *
Home phone: *
Cellphone: *
Email address: *
Valid until
(day/month/year)
Relationship : *
Email address : *
Cellphone :
Mother tongue: *
English *
French *
Other languages:
Contact name: *
Title/Position: *
Phone:
Please, add the country code
Please explain why you are applying and how that will enhance your educational goals: *
I certify that the information provided on this application form and in the accompanying documents is true, accurate, and complete. I understand that if I am admitted, the school has the right to cancel my registration at any time should there be any misrepresentation in the information I have provided.
If you need some help, please contact: incoming[at]igensia.com
The Institution is the data controller. The data collected by this form are the subject of computer processing for the purpose of transmitting the information and documentation requested. It is mandatory to fill in the fields with an asterisk (*). You may also receive our commercial offers if you have consented to them. The recipients of your data are the Institution’s staff in charge (administration department, billing service, communication and recruitment departments). Your data are only kept for the duration of the transmission of the requested information. If you have agreed to be contacted by our services and/or if you have agreed to receive requests from our services, we inform you that your data is kept under conditions that ensure its security and confidentiality for three years from its r collection or your last correspondence with us. In accordance with the applicable regulations, you may request access to your personal data from the controller, through its Data Protection Officer (DPO), whose contact details are below, rectification or erasure of these, or limitation of processing, or the right to object to the processing of your data under the conditions laid down in Regulation (EU) 2016/679 of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data. You are also informed of your right to lodge a complaint with the CNIL. Requests can be sent to the DPO by email at: dpo[a]igensia.com.