Online questionnaire

We need your answer to help you to find an accommodation.

If you have any problems with this questionnaire, send us an e-mail to: contact@science-accueil.org.  

Address of the visiting scientist
Family name: *	:
First name: *	:
Nationality: *	:
Sex (M/W) *	:	M W
Date of birth *	:
Address	:
Telephone	:
Fax	:
Email *	:
Academic level *	:	Professor Senior researcher Postdoctorate PhD student MBA HEC Trainee Other
Date of your PhD	:
Speciality *	:	Agronomy Arts Biology Botany Chemistry Data processing Economy Electrical / electronical engineering Engineerings Genetic Geography History International business Languages and literature Law Mathematics Medecine Pharmacology Philosophy Physics Political sciences Psychology Sciences of space Science of the ground Social sciences Theology zoology Other discipline
Contact language	:	French English
Dates and duration of your stay
Date of arrival *	:
Duration of your stay *	:	1 week 2 weeks 3 weeks 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months 13 months 14 months 15 months 16 months 17 months 18 months 24 months 36 months
To answer this request, person to contact	:	visiting scientist / gest laboratory both
Address of the laboratory
Host institute *	:
Laboratory / Service *	:
Address of your host laboratory / service	:
Last name of your contact in host laboratory / service *	:
First name of your contact in host laboratory / service	:
Telephone of your host	:
Fax of your host	:
Email of your host *	:
Request(s)
Your request(s)	:	Housing Administrative procedures Bank account Insurance Children (school, nurse...) French courses Leisure information Other information
Explain your request (for housing thank you to fill the form below) :	:
For housing (Only furnished)
Type of accommodation	:	Room Studio Flat House
For the room
Bathroom	:	shared personnal indifferent
Kitchen	:	not necessary essential
Do you smoke?	:	yes no
For all housing
Number of rooms (minimum)	:	Studio / 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6 rooms 7 rooms 8 rooms
Maximum rent	:	300 EUR 400 EUR 500 EUR 600 EUR 700 EUR 800 EUR 900 EUR 1000 EUR 1100 EUR 1200 EUR 1300 EUR 1400 EUR 1500 EUR 1600 EUR 1700 EUR 1800 EUR 1900 EUR 2000 EUR 2100 EUR 2200 EUR 2300 EUR 2400 EUR 2500 EUR 3000 EUR
How many people will share the housing (including you)?	:	1 person 2 persons 3 persons 4 persons 5 persons 6 persons 7 persons 8 persons
Family's structure (husband and wife, colleagues, age of children, ...):	:
Will you have a car?	:	yes no
Where do you want to be situated	:
Will you have a pet ?	:	yes no
Miscellaneous	:
* : mandatory field

C.N.I.L. (Commission Nationale de l'Informatique et des Libertés) : the information about yourself kept in the files of Science Accueil may be given to scientific or technical public establishements, to French embassies abroad, to the Fondation nationale Alfred Kastler as well as to franco-foreign research associations. You can ask for or get this information corrected or suppressed, eventually, in accordance with the law in force on computer science, files and rights (law 78-17 / 6 January 1978). This questionnaire is compulsory. Without any answer from you, your form will be kept in the computer file.

You can download the resolution of the District council about the creation of a datafile with information about names (in french).