12 application form 2012 2013

7/30/2019 12 Application Form 2012 2013

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MASTER'S DEGREEAPPLICATION FOR ADMISSION

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PLEASE USE BLACK INK, BLOCK CAPITALS AND TICK BOXES AS APPROPRIATE.

PERSONAL DETAILS AS IT APPEARS ON YOUR PASSPORT

Surname/Family Name: ..................................................................................................................................

First Names: ............................................................................................ Title: Mr Mrs Miss

Date of Birth: ............. / ............ / ............. Sex (): M FDay Month Year

Nationality: ............................................................ Country of Ordinary Residence: ................................

Home Address: Correspondence Address (if different):

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......................................... Postcode: .............................

Tel: ................................................................................

Fax: ...............................................................................

Email: ............................................................................

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......................................... Postcode: .............................

Tel: .................................................................................

Fax: ................................................................................

Email: .............................................................................

Address is valid from: ...................... to: .........................

PROGRAMME OF STUDY FOR WHICH YOU APPLY

Computer Science:

Applied Micro & Nanotechnologies : Wireless Communications Micro and Nano Systems

EDUCATION - QUALIFICATIONS ALREADY OBTAINED AND CURRENTLY BEING TAKEN

Detail your education since age 17. Start with the most recent qualifications.

Name of College/University Start date(Month/Year)

End date(Month/Year)

Diploma/Degree andSpecialization or Major

Overall classgrade/GPA

ENGLISH LANGUAGE

Is English your first language or your studies language? () Yes No

If no, provide any English language test certificate.


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FRENCH LANGUAGE

Is French your first language? () Yes No

EMPLOYMENT

List your employment to date. You may include a copy of your curriculum vitae if it is more convenient.

Name and Address of Employer

(state country

Start date

(Month/Year)

End date

(Month/Year)

Position held and main duties

SUPPLEMENTARY PERSONAL STATEMENT

Describe your academic interests and reasons for applying. Detail your career objectives and any relevant non-academic achievements as well as any publications. Outline any other relevant experience including attendance at

specialist workshops or short courses.

FUNDING

How will you be financing your studies at ESIEE Paris? Please tick one or more boxes.

Personal/Family Resources Loan Studentship/Scholarship................. Sponsorship

Other (please specify):

KNOWLEDGE OF ESIEE PARIS

Where did you learn about the ESIEE Paris programme you applied for?

ESIEE Paris website Other website (please specify): ........................................................................

Prospectus/departmental brochure ESIEE Paris academic staff Other academicstaff

Employer Former ESIEE Paris graduate Student recruitmentexhibition/fair

Campus France Other (please specify): .....................................................................................

APPLICANT'S DECLARATIONTo the best of my knowledge, the information on this application is accurate and complete. (Please note that ESIEEParis reserves the right to refuse admission or to terminate a student's attendance should it be discovered that he/shehas made a false statement or has omitted significant information. If you are offered a place, you will be required toprovide evidence of your qualifications.)


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Signature: ................................................................................ Date: ....................................................................


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PLEASE RETURN THIS FORM TOGETHER WITH:

2 Photos

Copy of passport or other official identification

2 letters of reference

English language test certificate (TOEFL, TOEIC, IELTS, Cambridge CAE, etc...)

or Proof of studies in English

Official transcripts from all prior undergraduate and graduate programmes (in English or French)

Details of the subjects studied and grades obtained for your Bachelor and Graduate/Master's (ifapplicable) programme (in English or French)

By Mail to: ESIEE Paris, International OfficeCit Descartes

2 boulevard Blaise PascalBP 99

93162 Noisy le Grand CedexFRANCE

or

By Email a scanned copy of the required documents in PDF format to:

[email protected]

12 application form 2012 2013

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