Master of Science and Engineering SMART CITIES - APPLICATION FORM - SECTION 1/3

APPLICATION FORM

Master of Science and Engineering (MSE)

SMART CITIES

Academic year 2016-2017 – Lille (France)

This formmust be fully completedand sent as soon as possibleto

Application is free of charge–The application deadline is April 27 th 2016

Minimum academic degree requirements include an awarded relevant Bachelor Degrees (or equivalent) for International students and an awarded “License” (or equivalent) for French students.Pending diplomas may also be considered.

Please also note that undergraduates with commensurate capacity or professional background in the fields of Energy, Environment or Habitat including Civil Engineering or Architecture, will also be considered for admission.

Upon examinationby a qualified jury you will receive timely notification of results. Pre-selected candidates willparticipate during June/July ina distance-examination session includingScientific/Technical Competence, General Background and Language.

Please note that only properly completed application forms will be examined by the jury.

More information is available on and

For further Information please send enquiries to

Section 1 - General Information

CANDIDATE INFORMATION

Family name

Given names

Date of birth dd/mm/yyyy Place of birth Country

Nationality Gender M F

Married YES NO If YES, Maiden name

POSTAL ADDRESS

StreetBuilding number

CityPostal code State

Country

CONTACTS

Phone number (with international area code)

Mobile phone (with international area code)

E-mail

Section 2 – Studies and Motivation Information

Family name

Surname

Higher education (including current Education background)

Academic year / Academic program / College / University / City / Country

Diplomas Granted

Level / Tittle / University / Country / Honors / Year of completion

Work experience (internships, jobs …)

From (date) / To(date) / Position and mission / Country

Language proficiency

Language / Level / Test taken (TOEFL, DELF, IELTS….) / Overall score
English / Excellent Good Medium Low
French / Excellent Good Medium Low No knowledge
Excellent Good Medium Low
Excellent Good Medium Low

Please explain here below your main motivations for theMaster of Science and Engineering SMART CITIES and how it will further your career goals (max 15 lines).

Section 3 – Supporting documents

Family name

Surname

To complete application the following documents must be sent (PDF file format) and received by April 27, 2016to:

Documents to enclose / Administration use
  1. Copy of passport or National ID (in English or French)
/ - received
  1. Digital Photo (standard passport size – JPEG file format)
/ - received
  1. CV with Photo
/ - received
  1. Copies of Transcripts of records of all Academic Training, including current year
/ - received
  1. Copies of awarded Diplomas
/ - received
  1. Copy of English Proficiency certificate
/ - received
  1. Copy of FrenchProficiency certificate
/ - received
  1. Option: Letter(s) of Recommendation from Professors, Administrators and Employers
/ - received

Please fill in the following section before sending your Application Form:

Application Form sections 1 to 3 must be completed, scanned and sent by email to: