Anne universitaire 20152016/

Academic year 2015-2016

D IREC TIO N

D ES

R ELA TIO N S I N TERN A TIO NA L ES

INFORMATION

Dossier de candidature / Application

A remplir par ltudiant / To be completed by the
student
Partie complter par le candidat. Ce document sera adress au responsable de master accompagn
de tous les justificatifs demands.
Section to be completed by the candidate. This document and all supporting information should be sent
to the person responsible for the masters program.

Information sur le candidat/Applicant information

Nom (identique au passeport) /Last Name (same as passport):

..................................................................

................................................................................................................................................................................................

Prnom (identique au passeport)/First Name (same as passport):

Genre/Sex: M

.............................................................

Date de naissance/Date of birth (MM/DD/YYYY): / /

Pays de naissance/Place of birth: ..............................................................................................................................
Nationalit/Nationality:
Adresse/Address:

.................................................................................................................................................

............................................................................................................................................................

E-mail/Email: @........................

Projet dtudes en France/Study program in France

Intitul du master/Name of masters degree: ......................................................................................................
Spcialit/Specialty: .......................................................................................................................................................
Niveau/Level:....................................................................................................................... M1
M2

Parcours universitaire/academic record

Dernier diplme obtenu/Last degree obtained: L3 M1 M2 Doctorat
Date dobtention/Date obtained (MM/DD/YYYY): / /
Diplme en cours dobtention (si cest le cas)/ Degree currently studying (if applicable ):

L3

M1

M2

Doctorat

Domaine disciplinaire/Field of Study:

......................................................................................................................

Nom de ltablissement dorigine/Name of the home institution: ...............................................................

................................................................................................................................................................................................

Ville/City:

...

Pays/Country: ............

Nombre dannes universitaires ou semestres valids ce jour/Number of years or semesters

fully completed at a
university as of today:

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Avez-vous reu des prix, distinctions?/Have you received any awards, distinctions?
Oui/Yes
Non/No
Si oui, merci de joindre lattestation votre dossier de candidature/If so, please include the
certificate with your application
Etes-vous auteur ou co-auteur de publications?/Are you the author or co-author of any
publications?
Oui/Yes
Non/No
Si oui, merci de les joindre/If so, please include them with your application
Avez-vous dj reu une bourse pendant vos tudes universitaires?/Have you already received
a scholarship during your university studies?
Oui/Yes
Non/No
Si oui prciser/If yes, please specify: ......................................................................................................................
Critres dattribution/According to which criteria were the scholarships awarded?
Mrite / Merit
Autres / Other:

Situation financire / Financial situation

.................................................................................................................................................................

Pour lanne universitaire 2015-2016/For the 2015-2016 academic year:

a) Avez-vous postul une autre universit en France ou ltranger ? Have you applied to
other universities in France or in another country?
Oui/Yes
Non/No
b) Avez-vous demand une bourse auprs dune autre institution?/Have you applied for a
scholarship in another institution?
Oui/Yes
Non/No
Envisagez-vous de faire ensuite une thse de doctorat?/Are you planning to write a doctoral
thesis after the Masters degree?
Oui/Yes
Non/No
Si oui, dans quel domaine?/If yes, in which field?
................................................................................................................................................................................................

Si non, quels sont vos projets professionnels ?/If not, what is your future career plan?
................................................................................................................................................................................................
................................................................................................................................................................................................
................................................................................................................................................................................................

Rfrences /References
Il est ncessaire de joindre votre dossier la lettre dau moins une personne
(enseignants ou chercheurs) qui puisse fournir des rfrences sur la candidature /
You are required to send a letter from at least one person (professor or researcher)
as a reference with your application.
Professeur rfrent contacter/Professor to contact :
Nom/Last name:

..............................................................................................................................................................

Prnom/First name:

........................................................................................................................................................

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Fonction/Position:

............................................................................................................................................................

Universit/University:
E-mail/Email:

....................................................................................................................................................

@........................

Comptences linguistiques / Language skills

Selon le candidat, quel est son niveau de franais et anglais/What is the students level in
French and in English:

Parl / Spoken:
Ecrit / Written:

Franais/French

intermediate
advanced

intermediate
advanced

Anglais/English

intermediate
advanced

intermediate
advanced

Avez-vous pass un test officiel danglais ou de franais? Did you pass a formal English or
French exam?
Oui/Yes
Non/No
Si oui, merci de joindre lattestation votre dossier de candidature/If so, please send the
certificate with your application.

PICES

OBLIGATOIRES FOURNIR PAR LE CANDIDAT

ET TRANSMETTRE AU RESPONSABLE DE MASTER / REQUIRED
INFORMATION TO BE PROVIDED BY THE CANDIDATE AND SENT TO THE
PERSON RESPONSIBLE FOR THE MASTERS PROGRAM
Les pices du dossier devront tre rassembles dans un mme fichier (PDF) et
nomm
de
la
faon
suivante :
nom_prnom_tablissement.pdf
(ex :
Dupond_Thomas_UPSUD.pdf) (5 Mo max)
All documents must be assembled in one PDF file and named as follows: last
name_first name_establishment.pdf (ex: Dupond_Thomas_UPSUD.pdf) (5
Mb max)
Le prsent dossier de candidature complt/The application complete with

supporting documents
Le CV complet de ltudiant/ The students complete resume
Une lettre de motivation/ A motivation letter
Une lettre de recommandation/ A recommendation letter
La liste des cours suivis au cours des 2 dernires annes/ The list of courses
taken in the last two years
Les relevs de notes des deux dernires annes et de lanne en cours/ The
grades of the last two years and the current year
Le classement gnral de ltudiant (si possible)/ The students rating (if
possible)
Photocopie du passeport/ Photocopy of the students passport

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Partie rserve au responsable de master/For use by the person responsible for the masters program.
Aprs rception du dossier complet du candidat, le responsable de master le fera valider par le service
des Relations Internationales de ltablissement dinscription du candidat.
After receiving the candidates complete application, the person responsible for the masters program
will have it validated by the International Relations Department of the establishment the student is
registering at.

Responsable du master concern

Service des Relations

Internationales de ltablissement
dinscription du candidat

Nom :.....
....

Nom:..

Prnom :....

..

..

Prnom:....

Etablissement :

...

Etablissement:....

Date:

..

...

..

Date:

Signature:

..

...

Signature et cachet de ltablissement :

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