MICROCREDENTIAL

MICROCREDENTIAL

INDIVIDUAL PRE-REGISTRATION FORM
Select your training course*
Instructions for completing and submitting your application

Please review all required information carefully before filling in the form.

You will not be able to save or edit your application once it has been started.

After clicking “I validate the submission of my application”,
please do not close the page until the confirmation message indicating that your application has been successfully sent by email appears on the screen.

Please note that applications will open from July 1.

The University is closed during the summer holiday period.
Applications cannot be processed between July 23 and August 19.

Application submitted during this period will be handled after reopening.
Title*
Birth Name*
Last Name*
First Name*
Date of Birth*

DayMonthYear
Date
Address*

Street number and name

Address line 2 / Apartment, suite, etc

CityState / Province / Region

Zip Code / Postal Code
Phone number*
Email Address*
example@example.com
• What do you expect from this training course ? (skills, knowledge, professional objectives)
Payment of Training Fees

Training fees : €320 (mandatory before submission).

Payement must be made online via the secure Esup-Pay platform.

Steps to follow :
1- Access the Esup-Pay payment link:
https://app.umontpellier.fr/esup-pay/evts/SCFCMicrocertificationSRERF/SCFCMicrocertificationSRERF
2- Enter the required information (last name, first name, email address).
3- Proceed with the payment by credit card.
4- After payment, a receipt will be sent to you by email.

You must upload this receipt to the present application form.
Please remember to check your junk mail (spam) folder if you do not receive the receipt.
Important notice :

• Any application submitted without proof of payment will not be processed.
• These fees are non-refundable, including in the event that the application is deemed ineligible.
• These fees cannot be covered by a third-party organization (employer, France Travail, CPF, OPCO, etc.).
DOCUMENTS TO PROVIDE

** PDF FORMAT ONLY **
Proof of payment *

Cancelof
Identity card – front*

Cancelof
Identity card – back*

Cancelof
Declarations and Signature

I certify that the information provided is accurate

I acknowledge that incomplete application will not be processed
Signature*
Date

DayMonthYear
Date
Should be Empty: