Application form

APPLICATION FORM

International Master of Science and Technology

Green Chemistry and Processes

for Biomass (Green CAP)


I am applying to:

- Master 1 (first year) 

- Master 2 (second year) 

Personal data

Family name (in block capitals): ................................................................................................................ First name(s): ............................................................................................................................................. Date of birth (D/M/Y): .............................................................................................................................. Place of birth: City: ..................................................... Country: ....................................................... Gender:  M  F

Citizenship: ...............................................................................................................................................
 Current address: ....................................................................................................................................

................................................................................................................................................................... City: ................................................................................ Postal code: ................................................. Country: .................................................................................................................................................... Phone: ............................................................................. Fax: ............................................................. E-mail: ..................................................... This address is valid until: .....................................................

 Permanent address (where you can be reached at all times): ...............................................................

................................................................................................................................................................... Tel: .....................................Fax: .................................... E-mail: .........................................................

 Person to contact in home country (in case of emergency):

Name: .............................................................................. Tel: ...............................................................................


Academic record
Home institution (Full name): ……………………………………………………………………............ Number of study years in higher education: ............................................................................................. Field of study: ...........................................................................................................................................

 Degree(s) obtained: ........................................................................... Year: ......................................

.............................................................................................................. Year: ......................................

............................................................................................................... Year: ......................................

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 Degree in preparation:.................................................. ......................................................................... Expected date of graduation:......................................................................................................................
Description of your main previous university courses (course titles related to this application)

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Languages
Mother tongue: .......................................................................................................................................... Language used in higher education: .......................................................................................................... Proficiency in English: Beginner  Intermediate  Advanced  Excellent 

Proficiency in French: Beginner  Intermediate  Advanced  Excellent 

Non native English or French speakers are requested to submit a certificate of proficiency, issued by a recognized institute.

Professional experiences and internships

Documents to be prepared

- Photocopy of passport or ID card

- Results of English language test (if your native language is not English): TOEIC (750) or TOEFL (550)

- Certified academic transcripts

- Certified copies of academic diplomas (to be translated into English or French by an accredited translator)
Documents to be sent
-Curriculum Vitae (resume) in English or French (max. 2 pages)

- Application form

- Short statement of motivation or professional project

- Lastest Marks (Bachelor for instance)

■ Accommodation: please precise which kind of accommodation you would prefer:

Room in a student hall of residence (depending on availability) 

Private accommodation* 
■ Financial resources:

How do you intend to finance your stay in France (fees, living expenses, …) ? .....................................

■ How did you hear about this Master course?
■ Statement
I hereby declare that I have answered the above questions truthfully.
Date: ................................................................................
Signature: ....................................................
This application form and the required documents should be sent by June 1st to:
Dr. Pascale DE CARO email :[e-mail]

Tel : [phone] - Fax : [phone]