Application Form

PERSONAL DETAILS of student:

BEKIN KUBRA MELEK FEMALE 18
Last name: First name: Gender: Age:
12/08/2006 TURKEY TURKISH TURKISH
Date of birth (DD/MM/YY): Country of birth: Mother tongue: Nationality:
nuripasa mah. 15 sokak no 15 daire 1 kat 1 burcu apartmani Zeytinburnu
Address:

Zip Code / City: 34025 / Istanbul Country: TURKEY Passport number: U31817950

+90 552 451 41 98 kmelekb@gmail.com

Mobile phone (student): E-mail:

Current School attended (if applicable):

PERSONAL DETAILS of student's emergency contact person (parent/guardian/other):
BEKIN ALIMCAN
Last name: First name:
nuripasa mah. 15 sokak no 15 daire 1 kat 1 burcu apartmani Zeytinburnu
Address:

Zip Code / City: 34025 / Istanbul Country: TURKEY Passport number:

+90 532 633 41 99
Phone (landline): Mobile phone:

Emergency number: E-mail:

COURSES
03/02/2025 24 WEEKS 24 WEEKS
Start of studies (DD/MM/YY): End of studies (DD/MM/YY): Number of weeks:

School Montreux, Switzerland Lyon, France Nice, France Berlin, Germany Freiburg, Germany
location:
Online Lessons Please specify which language: French German

STANDARD 20 INTENSIVE 25 PREMIUM 30

PRIVATE LESSONS Number of lessons / week:

COMBI 5 25 lpw COMBI 10 30 lpw

Goethe-Zertifikat B2* Goethe-Zertifikat C1* *Berlin only

EXAM PREP 30 lpw TELC B1 TELC B2 TELC C1 TESTDAF B2*

DELF B1 DELF B2 DALF C1 TESTDAF C1*

UNIVERSITY PATHWAY PROGRAMME Please also select corresponding study track

Course type:
Pre-evaluation process Application process University placement U20 +EXAM PREP U25 +EXAM PREP

Studienkolleg Introductory Module Studienkolleg Extension (Top-up) module

CAREER PATHWAY PROGRAMME (Berlin and Freiburg only) Please also select corresponding study track

Pre-evaluation process Recognition & Visa process Language course Career & relocation coaching

Family reunion C20 C25 Private courses

INTERNSHIP / WORK / VOLUNTEERING Please select corresponding STANDARD 20 or INTENSIVE 25 or PREMIUM 30 or

PRIVATE or COMBI 5/10 courses. Preferred sector / industry (not guaranteed)
Language
level: Beginner Elementary Upper Elementary Intermediate Upper Intermediate Advanced

Please send this application form to bookings@alpadia.com or directly to your study advisor. Page 1/2
 Application Form
ACCOMMODATION REQUESTS, MEDICAL CONDITIONS AND ALLERGIES Complete only if applicable

Arrival date: Departure date: Number of weeks:

Homestay Single room Double room Breakfast Half board (breakfast & dinner)
Name:
Student apartment
Single room Double room

Homestay no meals Single room Double room

Name:
Residence (en-suite)
Single room Double room

Studio Montreux only Single room Double room, only available for 2 participants booking together – fee per participant

Hotel-Residence** Lyon only Single room Hotel-Residence*** Lyon only Single room
Do you require a specific diet, have any allergies, medical conditions, regular medicine or treatments? NO YES
(please specify on a separate sheet)
Do you have any accommodation requests? (not guaranteed) NO YES (please specify on a separate sheet)
We will try our best to take your requests into consideration, but it cannot be guaranteed.
Requests sent AFTER the enrolment process won’t be taken into account.

TRANSFERS Complete only if applicable RETURN ON ARRIVAL ON DEPARTURE

Geneva GVA Lyon LYS Nice NCE Berlin Brandenburg BER

Airport transfer
Zurich ZRH Frankfurt FRA EuroAirport Bâle/Mulhouse EAP/BSL/MUL
Train transfer Geneva Zurich Lyon Nice Freiburg Berlin: please specify which train station

Arrival date (DD/MM/YY): Time: Flight/Train number: Arriving from:

Departure date (DD/MM/YY): Time: Flight/Train number: Departing to:

INSURANCE Compulsory

Do you require health / accident insurance cover valid in the country of destination?

NO, I have valid insurance cover. You will need to provide a copy of your insurance policy at a later stage.

YES, I wish to take out an insurance policy. Please send me the appropriate documentation. Price from € / CHF 15 per week.

BOOK WITH CONFIDENCE

Would you like to add Book with Confidence Guarantee? NO YES

MISCELLANEOUS Please read carefully

EDUVIZYON
How did you hear about Alpadia (official representative or other)? Please specify:
Have you already taken part in a language course? NO YES, organisation and location:
An application fee is added to all course prices: CHF 125 for the programmes in Switzerland / EUR 90 for the programmes in France and Germany.

An extra fee is added for last minute enrolments less than two weeks before the course start: CHF 45 / € 40.

I agree with all Alpadia’s terms and conditions. Place and date: 07/11/2024 Your local representative:

Signature of the student:

Signature of the parent or guardian (for students under 18):

Please send this application form to bookings@alpadia.com or directly to your study advisor. Page 2/2