Family name (in block capitals):
Date of birth (D/M/Y):
Place of birth: City: Country:
Gender: o M o F
n Current address:
City: Postal code:
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):
Home institution (Full name): ……………………………………………………………………..
Number of study years in higher education:
Field of study:
n Degree(s) obtained: Year:
n Degree in preparation:
Expected date of graduation:
Description of your main previous university courses (course titles related to this application)
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
- 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?
I hereby declare that I have answered the above questions truthfully.
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: