InterExchange Working Abroad | Au Pair in France Application
WORKING ABROAD Au Pair in France – Paris Region. Medical Report | Certificat medical. Name of the patient: Nom du patient: Address: Adresse: Are there any ...
Medical Report | Certificat medical Name of the patient: Nom du patient: Address: Adresse:
Are there any medical reasons against the patient going abroad as au pair? Du point de vue médical, quelque chose s’oppose-t-il à un séjour Au Pair à l’étranger?
Yes Oui
No Non
Yes Oui
No Non
Does the patient require a regular dose of medicine? If so, which? Le patient doit-il prendre régulièrement des médicaments? Si oui, lesquels?
Yes Oui
No Non
Has the patient been vaccinated sufficiently for a long-term residence inside Europe? Ses vaccinations sont-elles suffisantes pour un séjour prolongé en Europe?
Yes Oui
No Non
To your knowledge has/does the patient suff ered/suffer from an illness that suggests her not going abroad as au pair? Autant que vous le sachiez, le patient souff re-t-il ou a-t-il souffert de maladies qui représent une gêne pour un séjour Au Pair à l’étranger?
Yes Oui
No Non
If yes, which ones? Si oui, quoi? How is the physical and mental condition of the patient? Quelle est la constitution physique et psychique du patient? Does the patient suffer from any serious illness/es? Le patient souff re-t-il de maladies chroniques? If so, which ones? Si oui, lesquelles?
If yes, please give more information: Si oui, précisions:
Doctor’s name and address: Nom et adresse du médecin:
U .S . Department of State's Bureau of Educational and Cultural Affairs (ECA) . ...... be submitted electronically in the Department of Homeland Security's Student ...
16 juil. 2015 - The au pair stay will begin on __/ / (date) and the au pair will stay for months. If the au pair stay ends before this date, a minimum of 2 weeks' notice must be given by either party. The family speaks mainly. (language) at home. The
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