@ I nte rnsh i p certifi cate

(Attestation de stage)

INTERNSHIP CERTIFICATE
Loeo or THE HOST ORGANIZATION (ANESTATION DESTAGE)
(to6o oE I'ORGAN/SME D'ACCUEIL)
o be issued fo the intem upon the conclusion of the internship
( rqttre au stqiaire I'issue du stage)

THE HOST ORGANIZATION pRG ANISME D' ACcuEtL)

Name or company n ame (Nom ou Dnonnation sociale)'. ..........

Address (Adlesse):

a
Hereby certifes thal pertre que)

THE INTERN lrE sornr,

Last name om): ........... First name lPrro.): Sex: F D M tr Date of Birth Nte)'. _
Address (loresse: .........

4.................. . email:.........,..

A Sf UOglf OF (title of the training course or higher education cuniculum being followed by the intern):
(ETUDIANT EN (ntitul de la fomation ou du cutsus de I'enseignenent sutrreur suivi par le ou la stagiare ))

AT (name of the higher education institution or training organization) u s1tNde (nom de t'tissernent d'ensegnement sup$ieur ou de I'orgnne de fomaton))'.

has completed an internship as part of his/her studies effecftunstaseprvudanstecadredesesJs)

lm gRlsnlp DURtlOt puRE DU srAGE)

lnternship start and end dates: From ro,)......DD/MM/YYYY.,......,.,...,... To u) ............DD/MM/VYYY..

(Dates de dbut et de fn du st('e)

Representing a total duration of ............... (Number of months / Number of Weeks) (cross out any inappropriate item)
(Reprentant une dure totale de) (Nbre de ttois / Nbrc de Semain) (rayer la menton inutile))

The total duration of the internship is assessed in consideration of the actual presence of the student within the organization, subject any authorized time off
and leaves of absence granted, as provided under article L.124-13 of the education code (art. L.124-18 of the education code). Each period of at least 7 hours
of presence, whether consecutive or othenvise, is considered equivalent to one day of internship work, and each period equal to at least 22 days of presence,
consecutive or otherwise, is considered equivalent to one month.

&rode au mons gale 22 u de prsence corscutfs ou non est considr canne quivalente un mos.

Torll- nmoutr oF slpEND pArD To rHE TNTERN : (M1NTANT DE LA GRATrFtcAfloN vERsE AU srAGr,A/R,)

he intern has received an internship stipend totaling

(Le stagiare a peeu une gratfrcation de stage pour un nontanttotal de)

The course certiticate is an ndispensable element, for consideration, subjecf

to the payment of a fee, of the intemship work in determining retirement MADE lN ra,ra1
benefits. Retirement pensions legislation (Law No. 2014-40 of January 20, THls onv THe rru)
2014) grants sfudenfs whose intemship work is allocated a stipend the
possibility of having such work validated within two calendar quarters, subject
to the payment of a fee. The application is to be made by the student within Name, position and signature ofthe representative ofthe host
the two years of the end of the internship, and requires the presentation of OfganiZatiOn Uon, foncton et sgnature du rcprsentant de t'organsne d'accueil)
the intemship certifrcate indicating the total duration of the internship and the
total amount of the stipends paid. Specific information regarding the fee to be
paid and the procedure to follow may be requested from the Social Security
administration (Social Security Code, art. L.351-17 - Education Code, aft.
0.124-9).
L'attestaton de stage esf lndispersable pour pouvoir, sous /serue du versetment d'une cotisaton,
fare prendrc en conpfe /e sfage dans /es dolfs retraite. La lgislation su les retraites (loi n"2014-40
du 20 janvier 2014) ouvrc aux tudan dont le ste a t gratf la possibil de fare vald celui-ci
dans la limite de deux flmesres, sous rserve du versement d'une cotation. La denande est kire
par l'tudant dans les deux annes suvant Ia frn du stage et sur prsentaton oiligatoire de
I'attestati1n de stage nentonnant la dure totale du stage et le nontant total de Ia gratification perue,
Les informations prcises sur la cotsation veer et su la prccdure sulv/e sont demander
auprs de la scurit s^ciale (c1de de la scurt sociale art. L.351-17 -
code de l'ducaton
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