Toulouse agri campus

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APPLICATION FORM

Master of Sciences and Technology

Fluids Engineering for Industrial Processes

I am applying to:

- Master 1 (first year) o

- Master 2 (second year) o

Personal data

Family name (in block capitals):

First name(s):

Date of birth (D/M/Y):

Place of birth: City: Country:

Gender: o M o F

Citizenship:
n Current address:

City: Postal code:

Country:

Phone: Fax:

E-mail: This address is valid until:
n Permanent address (where you can be reached at all times):

Tel: Fax: E-mail:

n 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:

n Degree(s) obtained: Year:

Year:


Year:

n Degree in preparation:

Expected date of graduation:
Description of your main previous university courses (course titles related to this application)


Languages

Mother tongue:

Language used in higher education:

Proficiency in English: Beginner o Intermediate o Advanced o Excellent o

Proficiency in French: Beginner o Intermediateo Advanced o Excellent o
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 attached



Ø Do not send any original documents

Ø All copies must be translated into English or French by an accredited translator.
- 2 passport-size photos

- 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

- Curriculum Vitae in English or French (max. 2 pages)

- Short statement of motivation in English

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

Room in a student hall of residence (depending on availability) o Private accommodation* o

* We regret we cannot assist students in finding 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 April, 15th to:

INSA de Toulouse

LISBP - Equipe TIM (Nicolas DIETRICH)

135 avenue de Rangueil

31077 Toulouse cedex 4 - FRANCE
or directly by e-mail(including supplementary electronic documents) to:

e-mail: nicolas.dietrich@insa-toulouse.fr



Tel : +33 (0) [5-61-55-97-81]





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