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AESM application form
Master in Automotive for Sustainable Mobility
November 2014
Application form
Automotive Engineering for Sustainable Mobility MSc
Academic year 2015/2016
To be submitted by email prior to May 3rd, 2015
Polytech Orléans – Université d’Orléans
8 rue Léonard de Vinci – 45072 ORLEANS Cedex 2 – FRANCE
Tél. +33 2 38 49 24 63 - Fax +33 2 38 41 70 63 – [email protected]
1.
Personal data
PHOTO
Gender:
Mr.
Family name:
First name:
Date of birth:
Place of birth:
Nationality:
Country:
Postal address:
Area code:
Country:
City:
Phone #:
E-mail:
Cell phone #:
Mrs.
Miss
AESM application form
Master in Automotive for Sustainable Mobility
November 2014
2.
Education
Please list, from this year backwards:
- the institutions attended
- the courses taken
- the diplomas obtained with the corresponding marks and teachers' applications
- the breaks in studies, if any
- please enclose copies of all reports & transcripts listed
Duration from/to
Name of university & country
Subject & degree
achieved
Results & marks
Grade Point
Average
Date of award
2014/2015
2013/2014
2012/2013
2011/2010
2010/2011
Are you applying for other postgraduate programmes?
If so, which ones?
yes
no
AESM application form
Master in Automotive for Sustainable Mobility
November 2014
3.
Languages
Mother language:
English level
Please state your TOEFL (minimum 550), TOEFL IBT (minimum 80), TOEIC (minimum 750), or IELTS (minimum 6,5)
score & enclose the copy of the score report.
Score and type of evaluation:
French level & level of other languages
Have you studied French (if French is not your mother language)?
yes
no
Please indicate your level of skills in the languages listed below (from 0 to 5; 0 = no knowledge, 5 = excellent):
English
French
Reading comprehension
Conversation
Technical language
4.
Interest in the programme
Please write a separate letter (one or two pages) indicating your motivations and especially:
5.
•
why you are considering this programme
•
how you consider this programme for your career
Financial support
Please indicate your financial support for the duration of the programme.
Have you applied for a scholarship?
If so, which institution are you in contact with for a scholarship?
yes
no
AESM application form
Master in Automotive for Sustainable Mobility
November 2014
6.
Academic or Industrial references
Provide the names and complete contact information of your two referees knowing your work and ready to evaluate your
study capabilities that the selection committee can contact for further information.
1st referee
2nd referee
Name
Title
Institution / Company
Address
Country
Tel #
Fax #
E-mail
I certify that all the information given above is accurate. All the documents required are enclosed. I am aware that if any
incorrect data was to be found, my application could be rejected or studies interrupted without warning.
City:
Date:
Signature:
AESM application form
Master in Automotive for Sustainable Mobility
November 2014
7.
Checklist
Your application file must include the following documents:
Application form
Certified copies of transcripts
Certified copy of passport
Letter of application outlining rationale for wanting to undertake the programme
CV
Curriculum of courses that you followed in your home university
Certified copies of your diplomas
Two reference letters of referees knowing your work
Photocopy of score report for the English level & French language certificates you may have
Send your application file to:
[email protected]