MASTER'S DEGREE

APPLICATION 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: ............................................................................................
Miss
Date of Birth: ............. / ............ / .............
Day

Month

Year

Nationality: ............................................................

Sex (): M

Title: Mr

Mrs

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

Home Address:

Correspondence Address (if different):

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

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

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

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

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

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

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

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 and
Specialization or Major

ENGLISH LANGUAGE
Is English your first language or your studies language? ()
If no, provide any English language test certificate.

Yes No

Overall class
grade/GPA

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 nonacademic 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
Other (please specify):

Studentship/Scholarship................. Sponsorship

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
staff

Employer

ESIEE Paris academic staff

Former ESIEE Paris graduate

Other academic

Student recruitment

exhibition/fair

Campus France

Other (please specify): .....................................................................................

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

Signature: ................................................................................

Date: ....................................................................

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 (if
applicable) programme (in English or French)

By Mail to:

ESIEE Paris, International Office

Cit Descartes
2 boulevard Blaise Pascal
BP 99
93162 Noisy le Grand Cedex
FRANCE

or
By Email a scanned copy of the required documents in PDF format to:
intmaster@esiee.fr