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APPLICATION FORM
  ABOUT THE STUDENT

       Mr.        Mrs.          Miss       Ms.

Family Name
                                                                                                                      PHOTO
First Name

Occupation

      Male               Female         Nationality

Date of Birth: Day                     Month                           Year                                Please send this form to:

Mailing Address                                                                                            The Admissions Department
                                                                                                           Les Roches
City                                                    Postal Code                                        International School
                                                                                                           of Hotel Management
                                                                                                           Rue du Lac 118 - 4th ïŹ‚oor
State                                      Country
                                                                                                           CH-1815 Clarens - Switzerland

Home Phone                                          Mobile Phone                                           Phone:    +41 (0)21 989 26 44
                                                                                                           Fax:      +41 (0)21 989 26 45
Fax                                                 E-mail                                                 E-mail: admissions@lesroches.edu
                                                                                                           Website:   www.lesroches.edu


   EDUCATION
School - College - University                         Highest QualiïŹcation                              Date or projected Completion Date




   PROFESSIONAL EXPERIENCE                            YES      NO
Most Recent Company/Hotel                             Position Held                                     Dates




   ABOUT THE PARENT OR LEGAL GUARDIAN AND FINANCIAL SPONSOR

       Mr.        Mrs.          Miss       Ms.           Nationality

Family Name                                                            First Name

Profession

Mailing Address

City                                      Postal Code                          Country


Home Phone                                     Work Phone                                   Mobile Phone

Fax                                                           E-mail

If you reside in Switzerland, please specify if you have a:            Swiss B permit        Swiss C permit


Are you the Financial Sponsor?           Yes        No, then please ask the ïŹnancial sponsor to ïŹll in the details below


      Mr.       Mrs.        Miss                         Nationality

Family Name                                                             First Name

Profession

Mailing Address

City                                      Postal Code                          Country


Home Phone                                       Work Phone                                 Mobile Phone

Fax                                                           E-mail


Registered ofïŹce: GESTHOTEL SĂ rl – CH-3975 Bluche, Randogne
ACADEMIC PROGRAM
Please tick the program you wish to enroll on (one choice only).                        The courses below start either in February or August:
The courses below start either in January or July:                                      A2       BBA in International Hotel Management with
                                                                                                 Entrepreneurship or         Finance or        Marketing or
A1           Hotel Management Diploma
                                                                                                 Hotel Design & Project Management or              Culinary Business
B            MBA in Hospitality with
                                                                                        D1       Post Graduate Diploma/Professional Dipoma in Hospitality
                  Finance or               Marketing
                                                                                        D2       Post Graduate Higher Diploma in International Hospitality Management
C1           Intensive English Language Course                                          D3       Post Graduate Diploma in Business Administration for Culinary Arts

C2           HO1 + Special Intensive English Language Course                                     Professionals
                                                                                        Transfer option:

Please indicate the year you wish to start:                                             During my studies (only applicable for A1 and A2), I would be interested
                                                                                        in transferring to:      Les Roches Marbella in Spain or
January 20            July 20
                                                                                                                 Les Roches Jin Jiang, Shanghai, China or
                                                                                                                 Blue Mountain Hotel Management School, Australia

     HOW DID YOU FIRST HEAR ABOUT US ?
      Les Roches Educational Counselor*                              Industry Professional                       Student / Alumnus               Advertising / Article*

      Education Fair*                                                Internet – Website                          Your School Counselor*

      Other. Please specify:                                                                     *Please give the name:


     MOTHER TONGUE AND ENGLISH LEVEL
If English is not your mother tongue or if you have not spent at least 3 years in an Englsih speaking school, please indicate the score
of one of the following:

      TOEFL Score:                                            Cambridge First CertiïŹcate Score:                                           IELTS Score:

      Other QualiïŹcation Title:                                                                 Your Mother Tongue:


     LAPTOP OPTION
      I will bring my own laptop which meets the institution’s requirements                                   I would like to purchase the laptop through Les Roches


     ROOM AND BOARD - ADDITIONAL OPTIONS
I would like the following arrangement:

     A double room (2 beds), if available

     A single room, if available*

     A parking permit*
     * Please refer to the Tuition Fees for the additional fee to be paid by semester



    APPLICATION FEE                                                                             VERY IMPORTANT
Please debit my credit card of CHF. 100.-                                                      Please return this form fully completed and make sure the following are
                                                                                               enclosed:
      Visa              Eurocard/Mastercard                      American Express                        copy of your High School Diploma/Degree or equivalent
                                                                                               ‱         copy of your        transcripts
Card number:                     /                /                   /                        ‱ School information with grading system*
                                                                                               ‱         copy of your English Language              (TOEFL, IELTS, etc.)*
Name:
                                                                                               ‱ Copy of work              (if available)
                                                                                               ‱ Your Curriculum Vitae (Resume)
Expiry Date:               /             Security Code:
                                         (on the back of the credit card)                      ‱ A Study Plan, duly dated and signed (250 words minimum)*
                                                                                               ‱ A Post Study Plan, duly dated and signed (150 words minimum)
                                                                                               ‱ Referral letter of professional or academic nature*
    STATEMENT                                                                                    (Post Graduate and Master students only)
                                                                                               ‱ 2 passport size photographs
I hereby declare that all information given on this form is exact and
                                                                                               ‱ 1 photocopy of your valid passport showing your name and nationality
complete. I acknowledge having read and understood this document and
                                                                                               ‱ A letter of commitment from the             sponsor
all other pertaining documents and will abide by them.
                                                                                               ‱ Duly        in, signed and stamped Medical                       Report
                                                                                                 * See admission requirements in the Academic Program leaïŹ‚et.
I understand that the fees are modiïŹed once a year and I accept their
revision (in summer). I hereby decline to abide by the Swiss law in case
                                                                                               Date and Signature of the student:
of a dispute related to the interpretation or to the execution of my legal
obligation towards Les Roches and accept the exclusive competence of the
Valais court.




Date and signature of the Financial Sponsor (if not the legal guardian):                       Date & Signature of the parent / guardian:
MEDICAL HISTORY
         TO BE FILLED IN BY THE APPLICANT                                                                                                 Please send this form to:

      Name                                                                                                                              The Admissions Department
                                                                                                                                        Les Roches
                                                                                                                                        International School
      Date of Birth: Day                   Month                           Year                                Male              Female
                                                                                                                                        of Hotel Management
                                                                                                                                        Rue du Lac 118 - 4th ïŹ‚oor
      Name of the Parent / Guardian                                                                                                     CH-1815 Clarens - Switzerland

                                                                                                                                          Phone:       +41 (0)21 989 26 44
                                                                                                                                          Fax:         +41 (0)21 989 26 45
                                                                                                                                          E-mail:      admissions@lesroches.edu
                                                                             Postal Code
                                                                                                                                          Website:     www.lesroches.edu

      State                                                  Country


      Home Phone                                                        Mobile Phone


      Fax                                                               E-mail


          PERSONAL HISTORY
       Did you ever had or do you suffer from:
                            No Yes   (if yes, when)                                 No Yes   (if yes, when/what)                              No Yes    (if yes, when)

          Chicken Pox                                                 Diabetes                                                       Mumps

               Rubella                                             Tuberculosis                                                     Measles

        Hepatitis A/B/C


       Any Neurological Condition: ( Eg: epilepsy, head injuries, etc.)
       Any Mental Condition (Psychological/psychiatrical):
       (eg: depression, Bipolar disorder, eating disorders etc.)

       Any Learning difficulties:
       (eg: dyslexia, dyscalculia, ADHD, ADD etc.)
       Accident/disorder with physical long term consequences:

       Allergies to medicine or any other products



For the following points, please specify if you:

‱   Have had any other disease or have had an operation recently:

‱   Take any medication on a regular basis

‱   Are on a special diet

With regards to any of the above special needs or medical condition you may have, Les Roches aims to create an environment which enables all students to participate
fully in the campus life. To help us make reasonable adjustments, it is imperative to clearly indicate your medical condition and/or special needs (ie. dyslexia). Please
note that consideration of how we can meet any special needs is separate to the assessment of your academic suitability.

How would you describe your general health condition?                   Excellent            Very good             Good            Poor

In keeping with the institute’s policies regarding preventive health measures, the Campus Management may request a student to undergo a medical checkup or
mental health assessment at any time during her/his studies at Les Roches.

I hereby certify that the above information is correct and that I agree to undergo a medical or mental health assessment checkup if required. Deliberate false
statements may result in expulsion. Les Roches will not be held responsible in case of incorrect medical information stipulated on the medical certificate and
physician’s report.

We reserve the right to withdraw a student from Les Roches if we deem our internal health care support services are unable to meet the need of the student concerned
or if the student does not follow external medical advice and/or guidelines



Signature of the applicant                                                                                                date



Signature of the parent or legal guardian                                                                                 date

      Registered ofïŹce: GESTHOTEL SĂ rl – CH-3975 Bluche, Randogne
TO BE COMPLETED ONLY BY A PHYSICIAN
PHYSICIAN REPORT

                   Name of the patient


                   Date of Birth: Day            Month                   Year                                     Sex:        Male                 Female


                   Blood pressure                        MM/HG        Height (cm)                 Weight (kg)                 Pulse Rate


                     CLINICAL EVALUATION

                   Please indicate if the patient has experienced any problems with the following and attach a comprehensive report in French or English if
                   necessary:

                                                  Yes     No      Details

                   1. Skin

                   2. Head, Neck and Thyroid

                   3. Eyes and Ears

                   4. Mouth & Throat

                   5. Chest, Breasts & Lungs

                   6. Heart & Blood Vessels

                   7. Digestive System

                   8. Nervous System

                   9. Skeletal, Muscular System

                   10. Urinary, Reproductive System

                   11. Mental Health Disorders

                   12. Learning DifïŹculties

                   13. Others (specify)



                     REQUIRED LABORATORY TESTS / INFORMATION

                   Tuberculin Skin Test (TST). Please indicate date and results in mm                        or Blood Test:

                   Has the applicant been immunized against any of the folllowing. Please specify the dates and number of doses.

                                                                Yes      No                   Dates                                    Doses

                   Diphtheria


                   Whooping Cough


                   Tetanus


                   Poliomyelitis


                   Tuberculosis (BCG)


                   Hepatitis A


                   Hepatitis B



                     GENERAL IMPRESSION
                                                                                                                                                              RA43/R10/02.11/15M design: www.diabolo.com




                   The undersigned doctor certiïŹes that the general state of health, physical and mental condition of the applicant are excellent , that
                   he/she is not a carrier of any infectious disease and has no physical disability. The applicant can therefore comply, without risk, with
                   the strict requirements of professional training in the hospitality industry. The undersigned doctor also certiïŹes that the candidate
                   is not obliged to follow a special diet.




                   Date                                       Doctor’s signature and stamp

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Les Roches Application Form

  • 1. APPLICATION FORM ABOUT THE STUDENT Mr. Mrs. Miss Ms. Family Name PHOTO First Name Occupation Male Female Nationality Date of Birth: Day Month Year Please send this form to: Mailing Address The Admissions Department Les Roches City Postal Code International School of Hotel Management Rue du Lac 118 - 4th ïŹ‚oor State Country CH-1815 Clarens - Switzerland Home Phone Mobile Phone Phone: +41 (0)21 989 26 44 Fax: +41 (0)21 989 26 45 Fax E-mail E-mail: admissions@lesroches.edu Website: www.lesroches.edu EDUCATION School - College - University Highest QualiïŹcation Date or projected Completion Date PROFESSIONAL EXPERIENCE YES NO Most Recent Company/Hotel Position Held Dates ABOUT THE PARENT OR LEGAL GUARDIAN AND FINANCIAL SPONSOR Mr. Mrs. Miss Ms. Nationality Family Name First Name Profession Mailing Address City Postal Code Country Home Phone Work Phone Mobile Phone Fax E-mail If you reside in Switzerland, please specify if you have a: Swiss B permit Swiss C permit Are you the Financial Sponsor? Yes No, then please ask the ïŹnancial sponsor to ïŹll in the details below Mr. Mrs. Miss Nationality Family Name First Name Profession Mailing Address City Postal Code Country Home Phone Work Phone Mobile Phone Fax E-mail Registered ofïŹce: GESTHOTEL SĂ rl – CH-3975 Bluche, Randogne
  • 2. ACADEMIC PROGRAM Please tick the program you wish to enroll on (one choice only). The courses below start either in February or August: The courses below start either in January or July: A2 BBA in International Hotel Management with Entrepreneurship or Finance or Marketing or A1 Hotel Management Diploma Hotel Design & Project Management or Culinary Business B MBA in Hospitality with D1 Post Graduate Diploma/Professional Dipoma in Hospitality Finance or Marketing D2 Post Graduate Higher Diploma in International Hospitality Management C1 Intensive English Language Course D3 Post Graduate Diploma in Business Administration for Culinary Arts C2 HO1 + Special Intensive English Language Course Professionals Transfer option: Please indicate the year you wish to start: During my studies (only applicable for A1 and A2), I would be interested in transferring to: Les Roches Marbella in Spain or January 20 July 20 Les Roches Jin Jiang, Shanghai, China or Blue Mountain Hotel Management School, Australia HOW DID YOU FIRST HEAR ABOUT US ? Les Roches Educational Counselor* Industry Professional Student / Alumnus Advertising / Article* Education Fair* Internet – Website Your School Counselor* Other. Please specify: *Please give the name: MOTHER TONGUE AND ENGLISH LEVEL If English is not your mother tongue or if you have not spent at least 3 years in an Englsih speaking school, please indicate the score of one of the following: TOEFL Score: Cambridge First CertiïŹcate Score: IELTS Score: Other QualiïŹcation Title: Your Mother Tongue: LAPTOP OPTION I will bring my own laptop which meets the institution’s requirements I would like to purchase the laptop through Les Roches ROOM AND BOARD - ADDITIONAL OPTIONS I would like the following arrangement: A double room (2 beds), if available A single room, if available* A parking permit* * Please refer to the Tuition Fees for the additional fee to be paid by semester APPLICATION FEE VERY IMPORTANT Please debit my credit card of CHF. 100.- Please return this form fully completed and make sure the following are enclosed: Visa Eurocard/Mastercard American Express copy of your High School Diploma/Degree or equivalent ‱ copy of your transcripts Card number: / / / ‱ School information with grading system* ‱ copy of your English Language (TOEFL, IELTS, etc.)* Name: ‱ Copy of work (if available) ‱ Your Curriculum Vitae (Resume) Expiry Date: / Security Code: (on the back of the credit card) ‱ A Study Plan, duly dated and signed (250 words minimum)* ‱ A Post Study Plan, duly dated and signed (150 words minimum) ‱ Referral letter of professional or academic nature* STATEMENT (Post Graduate and Master students only) ‱ 2 passport size photographs I hereby declare that all information given on this form is exact and ‱ 1 photocopy of your valid passport showing your name and nationality complete. I acknowledge having read and understood this document and ‱ A letter of commitment from the sponsor all other pertaining documents and will abide by them. ‱ Duly in, signed and stamped Medical Report * See admission requirements in the Academic Program leaïŹ‚et. I understand that the fees are modiïŹed once a year and I accept their revision (in summer). I hereby decline to abide by the Swiss law in case Date and Signature of the student: of a dispute related to the interpretation or to the execution of my legal obligation towards Les Roches and accept the exclusive competence of the Valais court. Date and signature of the Financial Sponsor (if not the legal guardian): Date & Signature of the parent / guardian:
  • 3. MEDICAL HISTORY TO BE FILLED IN BY THE APPLICANT Please send this form to: Name The Admissions Department Les Roches International School Date of Birth: Day Month Year Male Female of Hotel Management Rue du Lac 118 - 4th ïŹ‚oor Name of the Parent / Guardian CH-1815 Clarens - Switzerland Phone: +41 (0)21 989 26 44 Fax: +41 (0)21 989 26 45 E-mail: admissions@lesroches.edu Postal Code Website: www.lesroches.edu State Country Home Phone Mobile Phone Fax E-mail PERSONAL HISTORY Did you ever had or do you suffer from: No Yes (if yes, when) No Yes (if yes, when/what) No Yes (if yes, when) Chicken Pox Diabetes Mumps Rubella Tuberculosis Measles Hepatitis A/B/C Any Neurological Condition: ( Eg: epilepsy, head injuries, etc.) Any Mental Condition (Psychological/psychiatrical): (eg: depression, Bipolar disorder, eating disorders etc.) Any Learning difficulties: (eg: dyslexia, dyscalculia, ADHD, ADD etc.) Accident/disorder with physical long term consequences: Allergies to medicine or any other products For the following points, please specify if you: ‱ Have had any other disease or have had an operation recently: ‱ Take any medication on a regular basis ‱ Are on a special diet With regards to any of the above special needs or medical condition you may have, Les Roches aims to create an environment which enables all students to participate fully in the campus life. To help us make reasonable adjustments, it is imperative to clearly indicate your medical condition and/or special needs (ie. dyslexia). Please note that consideration of how we can meet any special needs is separate to the assessment of your academic suitability. How would you describe your general health condition? Excellent Very good Good Poor In keeping with the institute’s policies regarding preventive health measures, the Campus Management may request a student to undergo a medical checkup or mental health assessment at any time during her/his studies at Les Roches. I hereby certify that the above information is correct and that I agree to undergo a medical or mental health assessment checkup if required. Deliberate false statements may result in expulsion. Les Roches will not be held responsible in case of incorrect medical information stipulated on the medical certificate and physician’s report. We reserve the right to withdraw a student from Les Roches if we deem our internal health care support services are unable to meet the need of the student concerned or if the student does not follow external medical advice and/or guidelines Signature of the applicant date Signature of the parent or legal guardian date Registered ofïŹce: GESTHOTEL SĂ rl – CH-3975 Bluche, Randogne
  • 4. TO BE COMPLETED ONLY BY A PHYSICIAN PHYSICIAN REPORT Name of the patient Date of Birth: Day Month Year Sex: Male Female Blood pressure MM/HG Height (cm) Weight (kg) Pulse Rate CLINICAL EVALUATION Please indicate if the patient has experienced any problems with the following and attach a comprehensive report in French or English if necessary: Yes No Details 1. Skin 2. Head, Neck and Thyroid 3. Eyes and Ears 4. Mouth & Throat 5. Chest, Breasts & Lungs 6. Heart & Blood Vessels 7. Digestive System 8. Nervous System 9. Skeletal, Muscular System 10. Urinary, Reproductive System 11. Mental Health Disorders 12. Learning DifïŹculties 13. Others (specify) REQUIRED LABORATORY TESTS / INFORMATION Tuberculin Skin Test (TST). Please indicate date and results in mm or Blood Test: Has the applicant been immunized against any of the folllowing. Please specify the dates and number of doses. Yes No Dates Doses Diphtheria Whooping Cough Tetanus Poliomyelitis Tuberculosis (BCG) Hepatitis A Hepatitis B GENERAL IMPRESSION RA43/R10/02.11/15M design: www.diabolo.com The undersigned doctor certiïŹes that the general state of health, physical and mental condition of the applicant are excellent , that he/she is not a carrier of any infectious disease and has no physical disability. The applicant can therefore comply, without risk, with the strict requirements of professional training in the hospitality industry. The undersigned doctor also certiïŹes that the candidate is not obliged to follow a special diet. Date Doctor’s signature and stamp