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: ......................................
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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?
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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 :pascale.decaro@ensiacet.fr
Tel : +33 (0)5 34 32 35 05 - Fax : +33 (0)5 34 32 35 97