School of engineering

Supported by the Chamber of Commerce and Industry of Rouen

FRANCE

APPLICATION FORM

Master of Science

Business Information Systems

ACADEMIC YEAR 2010 / 2011

Student’s Family name : …………………………………

First name : ……….…………………………….…… Photograph

Country :……….. ……………………………

Please return this application to

ESIGELEC – Programmes « Masters of Science »

Technopôle du Madrillet
Avenue Galilée, BP10024
76801 Saint Etienne du Rouvray – FRANCE
Tél : +33 (0)2 3291 5858 – Fax : +33 (0)2 3291 5859
E mail : marteaux@esigelec.fr

DEADLINE

 September 10th, 2010


STUDENT’S PERSONAL DATA (to be completed by the student applying)

Family name: …………………………….. First name (s) : …………………………………

Date of birth: ……………………………... Place of Birth: ………………………….……….
Sex: ............Nationality:………………....
Current address: Permanent address (if different):
…………….………………………………. ..........................................................................
…………………………………………….. ..........................................................................
Country : ………………………………… ..........................................................................
Current address is valid until: Country :...........................................................
………………………................................ Tel.: ……….......................................................
Tel.: ………………………………………. Fax : ……………………………………………….
E-mail: ……………………………………. E-mail.:..............................................................

LANGUAGE COMPETENCE

Mother tongue: ……………………………………………………………………………………

Language of instruction at home institution (if different): ...................................................

Languages I am currently I have sufficient I would have sufficient

studying this knowledge to follow knowledge to follow lectures
language lectures if I had some extra
preparation
Yes No yes no yes No
.English...........

.French………

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

PREVIOUS AND CURRENT STUDY

Diploma/degree for which you are currently studying: …………………………………………

Number of higher education study years prior to departure abroad: ..................................
Have you already been studying abroad ?
Yes
No
If Yes, when ? at which institution ?
……………………………………………………………………………………………………..
RECOMMANDATION LETTERS (Name of Referee you have asked to fill in a
Recommandation Letter)

Name and full address: ...................................................................................................

...............................................................................................................................................
Position :............………………………………………………….

Employer :…………………………………………………………

Full contact details (telephone, fax and e-mail)

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

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

Date : ……………………………………………….

Student’s Signature………………..………………

Please enclose

1. Personal Resume (benefit from the Master you are expecting, how do you see your
career progressing, your major strengths and weaknesses, adaptation to new
situations, do you consider yourself to be international in outlook, personal interests,
any additional information which could help in understanding your motivations)
2. Curriculum Vitae
3. Copies of previous degrees
4. Your official academic transcripts
5. TOEFL score, or equivalent (If not possible, anyhow there will be an interview to
evaluate your level of English and your motivation)
6. Copy of the passport or ID card
7. 2 letters of recommendation (to be sent with your application form or separately)
 School of engineering
Supported by the Chamber of Commerce and Industry of Rouen
FRANCE

ESIGELEC offers courses in the following fields:

Telecommunications
Electronics
Information technologies,
Networks
Computer engineering
Embedded systems
Automation and robotics
Electrical engineering and transport
Mecatronics
Finance & Engineering
Business Engineering
Biotechnologies

FRANCE

Normandy

ESIGELEC ROUEN
www.esigelec.fr

Technopôle du Madrillet
Avenue Galilée, BP10024
76801 Saint Etienne du Rouvray – FRANCE
Tél. +33 (0)2 3291 5858 - Fax +33 (0)2 3291 5859
 School of engineering
Supported by the Chamber of Commerce and Industry of Rouen
FRANCE

Confidential letter of Recommendation

Master of Science

Business Information Systems

ACADEMIC YEAR 2010 / 2011

Dear Madam, Dear Sir,

The student who has provided you with this letter is in the process of applying for a place in a Master of Science
Programme at ESIGELEC Rouen School of Engineering. This is a high level educational course which serves to
complete a strong initial education and/or a first professional experience. Therefore, if you would fill in this letter
of recommendation and address it directly to us, we would be very grateful.
Sincerely.

Please return this application to

ESIGELEC – Programmes “Masters of Science”

Technopôle du Madrillet
Avenue Galilée, BP10024
76801 Saint Etienne du Rouvray – FRANCE
Tél : +33 (0)2 3291 5858 – Fax : +33 (0)2 3291 5859
E mail : marteaux@esigelec.fr
 What are his/her strongest points?
Student’ s name:
..........................................................................
……………………………..
..........................................................................
How long have you known the
..........................................................................
candidate, and in what situation did you
What are the areas in which the candidate
meet? ……………………………...
could improve?
…………….……………………………….
..........................................................................
……………………………………………..
..........................................................................
……………………………………………..
..........................................................................
……………………………………………..
..........................................................................
……………………………………

EVALUATION OF THE CANDIDATE

Remarkable Very good Good Average Below

average

Analytical
skills

Creativity

Summary
skills

Ability to
communicate

Sociability

General
assessment

Your surname, First Name :

Profession : Company name :

Professional address :

Post code : Town : Country :

Phone number Email :

Signature and Stamp :