Application form - Faculté de médecine Paris Descartes

Master of Science in Public Health: Comparative Effectiveness Research
Course directors: Professor Philippe Ravaud and Professor Isabelle Boutron
Application Form (2016 – 2017)
Personal Information
☐Mr
☐Ms
☐Mrs
Last (family) name
Spouse name (if any)
First name
Date of birth dd/mm/yr
Place of birth/country
Current citizenship(s)
Address
Permanent address
Post code, City
Country
E-mail
Phone number
(required)
Situation
☐ You are from France
☐ Student
☐ You are from a European country
☐ You are from other country
☐ Other
(please specify your
status if you are not a
student)
Your background
☐ Medicine
☐ Pharmacy
☐ Biostatistics
☐ Other (please specify)
Educational background
Name of institution(s)
City/Country
Field
Degree obtained/expected
most recent first
NOTE: To be admitted to the one year MS programme you must hold a Master year 1 degree or an equivalent.
Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS)
Hôpital Hôtel-Dieu, 1 place du Parvis Notre-Dame, 75004 Paris, FRANCE
Tel : +33 (0)1.42.34.78.32,
[email protected]
www.masterCER.com
1
Year
Work experience(s), if you lack any working experience include relevant internships
Current / the most
recent position
Name of employer
Department
Duration
Position name
Job description
Position
Other previous relevant
positions or internships
Company
Duties
Other research related questions
How did you learn about this
MS programme?
☐ Academic/professional
network
☐ Internet
☐ Other (please specify)
Do you know where you will
do your internship (if known)?
Name of the research
supervisor who agreed to host,
and the host research
laboratory (if known)?
What will be your research
topic (in known)?
Do you receive any
scholarships (if any)?
Language requirements
Level in English (IELTS, TOEFL, TOEIC)
Level in French
☐Native language
☐Native language
☐None*
☐ None
☐Basic*
☐Basic
☐Fluent
☐Fluent
*NOTE: a good command of English is required to attend the MS programme. If your first language is not English and if your previous degree
has not been taught entirely in English, you will be required to provide some evidence of your English language proficiency (TOEFL, TOEIC,
IELTS).
Letters of recommendation
Name and Title
Contact details (including email address)
Individuals
familiar with your
1
academic and/or
professional
work
2
Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS)
Hôpital Hôtel-Dieu, 1 place du Parvis Notre-Dame, 75004 Paris, FRANCE
Tel : +33 (0)1.42.34.78.32,
[email protected]
www.masterCER.com
2
Checklist of required application documents
Please note that the submission of the following documents is mandatory. Incomplete applications will not be accepted.
This application form should be filled in electronically and only in English language
Please be sure to attach all required documents
APPLICATION DEADLINE IS 1 MAY 2016
☐A duly filled out application form
☐A personal statement addressing your interest in a specific programme and your future career goals (400 – 600 words)
☐Curriculum Vitae
☐Two letters of recommendation
☐A scanned copy of your last or relevant diploma and its translation if it is not in English or French
☐An official transcript and its translation if it is not in English or French
☐Evidence of English language proficiency, if any. If your first language is not English and if your previous degree has not been taught entirely
in English, you will be required to provide some evidence of your English language proficiency (TOEFL, TOEIC, IELTS).
Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS)
Hôpital Hôtel-Dieu, 1 place du Parvis Notre-Dame, 75004 Paris, FRANCE
Tel : +33 (0)1.42.34.78.32,
[email protected]
www.masterCER.com
3