APPLICATION FORM
INSTITUTIONAL FINANCING
CANDIDATE
Title : Mr Mrs
SURNAME (maiden name for married women):
USUAL NAME (married name for married women):
First name:
National insurance number: ___| ______| ______ |______| _________ _________ ______
Date of birth: |__|__| |__|__| |__|__||__|__|
Place of birth: Town:______Country: ______
Nationality:
Marital Status :single married widowed divorced partner
separated partner in a civil solidarity pact
Number of children: |__|__|
Address:
postal code: Town :
Telephone number:
Email:
Professional situation:
Are you in a position of civil servant: YES NO
If you are concerned, are you trainee permanent employee
Detail your civil servant degree: ______place of nomination ______
Do you have the aggregation: YES NO
If you do, point out the wording and year:
PREVIOUS TRAINING
Bac + 5 years of further education diploma: Master Engineer other, tell precisely:
Country where you got it:
School of education:
Date of getting:
Speciality of your diploma:
Do you have the aggregation: YES NO
Are you a former student from a National Institute: YES, point out which one ______ NO
Distinction: congratulation Very good Good Quite good Only average
THESIS
Doctoral Schools :
n°521 Information Science and Engineering
n°522 Materiels, Mechanical, Energy and Aeronautical Science and Engineering
n°523 Enviromental Sciences « Gay Lussac »
n°524 Biology and health Sciences « Biohealth »
n°88 Law and Political Science « Pierre Couvrat »
n°525 Letters, Thought, arts and history « Civilization and Literature from Antiquity to today »
n°526 Societies and Organisations
n°527 Cognition, Behavior, language(s)
Research unit:
Title of the thesis:
PhD supervisor:
Mr Mrs
Surname: Firstname :
CNUsection: _________
Research Unit:
If there is a joint advisor, detail for each one:
Mr Mrs
Surname: Name:
Authorization to direct researches: Yes No
CNU Section: _________
Research Unit:
Mr Mrs
Surname: Name:
Authorization to direct researches: Yes No
CNU Section: _________
Research Unit:
Kind of financing wishes:
PhD Contract regional grant (you can check both financing propositions if you are interested by each one)
Would you like to be sessional lecturer: YES NO
PAPERS TO JOIN with this application form :
Curriculum Vitae,
Cover letter with professional plan,
copy of Master report card and of certificate of achievement,
thesis project (between 3 et 4 pages),
one page popularized summary of your thesis project in French
substantiated recommendation from the PhD supervisor to give you a financial support
copy of an ID card
These documents have to be return by email at
not later than the June, 11th 2014.
Contact : Claire BUISSON
Université de Limoges – Pôle Recherche - Collège Doctoral
33 rue François Mitterrand - BP 23204 - 87032 Limoges
: 05 87 50 68 92Fax : 05 55 14 91 08