APPLICATION FORM FOR ATOSIM MASTER PROGRAM

2014-2016

Please read the instructions carefully before completing this application form.
Only complete application forms will be processed.
This application form consists of the following parts:
Part A – Personal details
Part B – Language Proficiency
Part C – Academic Qualification
Part D – Curriculum Vitae and Employment Information
Part E – Motivation
Part F – References
Part G – Financial Information
Part H – Survey
Part I – Checklist
Part J – Declaration and Signature
Part K – Reference Form
Part L – CV Template
Who should use this application form?
All students applying to the ATOSIM Master programme should use this form.
How to complete this application form?
• Please USE STANDARD FONTS (Arial, Verdana or Helvetica 11, no bold or italic)
• All documents should be submitted in the same envelope
• All documents must either be originals or be certified copies
• If you are currently a student, please forward your final transcripts as soon as they are available
• Ensure that you complete the checklist and sign the declaration at the end of this form
NOTE: Applications which are not signed cannot be processed.

DEADLINE FOR APPLICATION (postmark and email submission):

January 5th 2014
The required documents have to be sent twice:
> ONCE BY SURFACE MAIL, to:
ENS de Lyon – CBP
ATOSIM Erasmus Mundus
46, allée d'Italie
69364 Lyon cedex 07
FRANCE
> THEN BY EMAIL, to atosim@ens-lyon.fr
Please note the subject of the e-mail must be: “EM ATOSIM application”
If possible, send .PDF copies (not .JPG, .JPEG, etc.)

..................................................................................... Part B – Language Proficiency Mandatory English Language Proficiency Only students who had their bachelor education in Canada............................. First name:..................................... Address for correspondence Street and number: ............................. Liechtenstein.................................................................................................................................................. Date of birth (dd/mm/yy):..................................................................................................................................................................................................................................................... Do you have a French/Dutch/Italian residence permit? yes no Please specify: Expires on: Do you need a student visa for France/The Netherlands/Italy? yes no NOTE: You do not need a visa if you are a citizen of one of the countries belonging to the European Union or of: Switzerland........ Marital status:............................................................................................................................................................... Nationality:....................... Score obtained:........... if you are accepted in the ATOSIM programme..................... E-mail address:.................................... Japan... State:................................................................................................................................................................................ Permanent address (e.............. Mobile:.............................. not applicable if you are Chinese) The period between the proficiency test and this application should not exceed two years....... City:.........................................B (CPE) (in both cases................................ Score obtained:.................................................. State:......................................... Norway........................................... The minimum language requirements are as follows: • TOEFL test: minumum score 92....... next of kin) Street and number:...................................... E-mail address:............ we will assist you with your visa application...................................................................................................5............................................ at least 6 on each sub-score (Academic test ..............................A.......................................................................................................................................................................................................................................... Australia. Ireland.................................................. New Zealand........................................................................................................................................................................ New Zealand................... Other initials:................................... Please complete the following if applicable.......................................................................................................................................................................................... Mobile:...................... Postal code:.................................................................................................................Part A – Personal Details Mr Mrs Ms Last name:........................................................................ Telephone:................. Telephone:.... Australia do not need to send in an English language test..................................................................................... Fax number:............................................................. 2) Other (dd/mm/yy):.................................................................................................... 1) Date of IELTS test (dd/mm/yy):................................................................... Citizens of the above mentioned countries should however apply for a residence permit after arrival...........................................................................................................S................................................................................................................................... 3) Do you fluently speak and/or read other languages? ...... However.....................................g................... USA................................................................Country:..................................................................................................................... UK........... country):....................................... A...................Country:.......................... Canada or the U.....................................................................................................................................................Postal code:........................................................................................................................... Fax number:............................. Monaco.................................................................................................. B (CAE)........ Iceland................... City:.............. not the General one!) • Cambridge International Examinations: minimum scores A................................................ .. Place of birth (city......... Please note that it is your responsibility to obtain a visa.................................................................... ...................................................................... at least 20 on each sub-score (237 computer-based/580 paperbased test) • IELTS test: minimum score 6.................

.............................................................................................. 1) First reference: Name:............................................................................. The letter of motivation should describe (in one page) their motivation for applying to this program. Field:..... Institution:............................................................................................................................... The letters are to be signed and preferably printed on letterhead.... Field:.......................................................................................................................................... Institution:.......... .................................... please provide information in the above format for all of your academic degrees. PhD................................................................................................................................................................ etc...................................................... Date obtained (dd/mm/yy):........................................................... If you have obtained more than one degree............................................................................................................................................ Please forward final grades of courses still in progress as soon as they are available............................................................................................................................................................ 3) Are you currently enrolled in a (non-)degree course or educational training relevant to your application? ............................................................................................................................................................................. 2) (Post)-Graduate Degree(s) (Masters....................................................................................................................... 2) Second reference: ........... including a list of courses still in progress... All applicants should include an up-to-date curriculum vitae (resume) attached to this application on a separate page.............................................................................. etc.. Title:..................................................................................................................................................... Organisation:................................................ We recommend the use of the provided model (see part K).................................................................................................... 1) Undergraduate Degree(s) or First University Degree(s) (Licence............................................ Part D – Current status and Curriculum Vitae Present status (student/employed/internship/unemployed/.................................................................................................................................................................................................................................................................................................... until:............................................... since: ………………………..... At least one letter should be supplied by a professor or academic advisor...................................... Organisation:............................................... E-mail address:..................................................................................................) Type of degree:............................................ Documents not in English should be accompanied by an official certified translation.. (Please use template) Part E – Motivation All applicants should include a letter of motivation attached to this application on a separate page................................................................................... Part F – References Please list the two persons you have asked to write a letter of recommendation for you..........................................................................):.............................................................................................................................................................Part C – Academic Qualifications NOTE: All applicants should include official transcripts of every institute of higher education attended............................................................ Telephone:........ Major………………Minor..................................... Date obtained (dd/mm/yy):.... Specialisation:...... Bachelor..............) Type of degree:...........................................................................................................................................................

.................. You are not obliged to provide this information................................................................................................................... Organisation:................ please specify which category you qualify for (the definitions of the categories can be found on the first page of this application form)................................................ ................................................................................cecam....................... Expected (summer) earnings:...... Family contribution:.................................... according to the EC...................................... “candidates can apply for an Erasmus Mundus scholarship to a maximum of three (3) different joint programmes” Statement of financial resources In case you intend to apply even if you do not benefit from an Erasmus Mundus grant................................... Title:................................ ................................................................................................. Sponsorships:.............................................................. Name of Sponsor (if applicable).....erasmusmundus-atosim.............................000 per year to cover living and other expenses.............................. please fill out this statement of financial resources (in Euro).................................................................................................................... Total Resources:............ Loans:........................................................................ Telephone:......................................................................................................................................................................... students must be able to finance their study and living expenses.................................................................................................................. that I fulfil the eligibility criteria (see http://www................................................................................................................................... Other resources:.......... a single student needs approximately €10.................................................................... Part G – Financial Information If you wish to apply for an Erasmus Mundus scholarship......................................................................... Student's own contribution:....... This is one of the requirements for being granted a residence permit..................................................................................... ..................................org/index..............................................................000-12.................html) Did you already benefit from an Erasmus Mundus fellowship in the past? yes/no Do you plan to apply (or have you applied) to other Erasmus Mundus Master Courses for the next academic year? yes/no If yes......................................... As a guideline............. This is in addition to the tuition fee................................................................................. Category A candidate Category B candidate I certify......................................... Please note that................................. E-mail address:...................................................................................................................................................... to prove that you have sufficient financial support from a sponsor or bank demonstrating your ability to pay the tuition fee and living expenses.............................................................................Name:......................................................................................... Indeed............................................................................................................... which?.......php/eligibility-criteria................................................................................................................................

......................... at least 20 on each sub-score (237 computer-based/580 paperbased test) • IELTS test: minimum score 6................................................................ in English Copy of Passport or other identification Certified copies of Proof of English proficiency • TOEFL test: minumum score 92.................................................................................................................. visit) (please specify*) Via our brochures and/or flyers An education exhibition (which one*) Graduates of our programmes Family/friends Facebook Other (please specify*) *. It will help us to update and maintain our information......................................................................................... Please indicate how you initially learned about our programmes and courses....................................... A...............................B (CPE) (in both cases.................. ........................................................................................................ Name of applicant:........................ not applicable if you are Chinese) Statement of Purpose: a motivation letter where you indicate why you want to join the ATOSIM programme Recommendation letters from the scientists mentioned in the application form Part J – Declaration & Signature I declare that the information provided by me is correct and complete........... in English Certified copies of Transcript of records.... I understand that incomplete information will delay the application process and I accept that incorrect information will render the application invalid............................ Date (dd/mm/yy):............... ................. Internet Contact with one of the partner universities (personal.............. Part I – Checklist I have included the following documents with my application: Signed printout of the online application form Certified copies of Diplomas.......... B (CAE)....... not the General one!) • Cambridge International Examinations: minimum scores A............. at least 6 on each sub-score (Academic test ....................................................................... City................................................. .......................................................................5......................................................................................................................... Signature. phone.............................................Part H – Survey Please fill out this short survey........................................................... country:.................................................................................

...............................................................................................Other initials:....................................................................Other initials:..................... .............................................................First/given:...................................................................................................................................................................................... ...... Phone number:................................................................................ .............................................................................................................................................................................. ...................................................................................................................................................................................................................................................................................................................................................................................................................................................... at least one letter should be supplied by a professor or academic advisor............................................................................ E-mail address:.................................................................. .............................................................................................................................................................. To the authors of the recommendation letters: Dear colleague................................................................................................ ............................................................................. Applicant: Last name:......................................................... We would appreciate........................................ Applying for the ATOSIM Master programme..................................................... ............................................................................................................................................................................. .................................................. ..................................................................................... ........... .......................... State:............................................................................................................................. We are interested in learning about the applicant's suitability for advanced studies................................Country:........................................ How long have you known the candidate and in what capacity? ............ ..................................................................................................................................................... Please transmit this template to the persons providing your recommendation letters.................................................................................................. We welcome your thoughts on the applicant's intellectual strengths and character..................................... if you could use the following form (preferably imported into a document printed on your own letterhead stationary)..................................................... ...................................................................................................................................................................................................................................................................................................................... The applicant should receive the letters in a sealed and signed envelope and include them in this form in the application material sent by surface mail.................................................. You may also use a separate letter (preferably on your own letterhead stationary) and attach it to this form............................................................Part K – Recommendation letter template All applicants should submit letters of recommendation from two persons.......................................................................................................... City:................................................................... ............................................................................................................................................................................................................................................................................................................................................. ................. .......................................................................................................................................... ..................... ........................................................... Please be as detailed and frank as possible... To the Applicant: Under no circumstances may applicants review or prepare letter of reference themselves........... ............................ Reference Address: Last name:................................................................................................................................First/given:............................................................................ Street and number:....................... Thank you for assisting us in our admission process.......................................................................................................................................................Postal code:........................................................................................ ...................... We welcome references that provide relevant information that cannot be found elsewhere in the application materials or that can provide an insight into the applicant's abilities and suitability for the academic work in general and the ATOSIM Master Course in particular........................................................................................ as well as his or her promise for success..

....................................................... .................................................................................................................................................................................................................................................................................................. ............................................................................................................................................................................................ . ................ ....... .................................................. .................................................................................................................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................................................... ........................................................................................................................ Date (dd/mm/yy):......................................................................... ................ country:..................................................................................................Please fill out the following table: Excellent Above Average Average Below Average Unable to Rate Knowledge in area of specialisation Ability to plan and carry out research/independent study Ability to plan and carry out research/independent study Analytical ability Maturity Motivation Leadership potential Social skills Intercultural skills Flexibility Creativity Oral communication skills Written communication skills Integrity Please indicate whether you would recommend the applicant for the programme he/she applied for and why......................................................................................................................................................................................................................................................................................................................................................................................... City.................................................... Signature:............................................... ................................................................................ ........................................................................... .......................................................................................................................................................

Curriculum Vitae Personal information LAST NAME(S) (FAMILY NAME) First name(s) (Given name) In applicable. title and subject of thesis Results or grade obtained Relevant training. internships and courses Academic year Principal subjects/occupational skills covered Name and type of organisation providing education and training Additional ____/____ ____/____ ____/____ . Academic year ____/____ ____/____ ____/____ Title of qualification awarded Date of graduation _ _ _ _ ____ ____ Principal subjects/occupational skills covered Name and type of organisation providing education and training Level in national or international classification If applicable. Maiden name(s) Address House number. Add separate entries for each relevant course you have completed. country Telephone Mobile E-mail Nationality Date and Place of Birth DD/MM/YYYY in Gender Desired employment / Occupational field University education Add separate entries for each academic program. city. starting from the most recent. street name postcode. starting from the most recent.Part L – CV Template Europass Insert photograph.

eu/LanguageSelfAssessmentGrid/en Self-assessment European level (*) Understanding Listening Reading Speaking Spoken interaction Writing Spoken production English French Dutch Italian German TOEFL or IELTS certificate Yes / no Score/test result English proficiency test Other competences Social skills and competences Replace this text by a description of these competences and indicate where they were acquired.cedefop. Computer skills and competences Replace this text by a description of these competences and indicate where they were acquired.Scientific or industrial Add separate entries for each relevant post occupied. Organisational skills and Replace this text by a description of these competences and indicate where they were acquired. full-time positions or extended internships Years Occupation or position held Main activities and responsibilities Name and address of employer Type of business or sector Personal skills and competences First language Other language(s) (*) Common European Framework of Reference for Languages http://europass. . starting from the most recent. Other skills and competences Replace this text by a description of these competences and indicate where they were acquired. competences Technical skills and competences Replace this text by a description of these competences and indicate where they were acquired.europa.

Publications List of scientific publications Title Author(s) Source Date of publication Title Author(s) Source Date of publication Title Author(s) Source Date of publication Title Author(s) Source Date of publication .Annexes .