邢唷> kmj欹 鳵DObjbj储储EZ秩秩 CCOOOccc8'|c./& q.s.s.s.s.s.s.$13.QO""".CC.&&&"C8q.&"q.&&:9,,67,泈`喰c#Te, ]..0./o,RN4 %BN4,N4O,s r& \A!..L&./""""N4 :  School of Engineering   GRANDE ECOLE D INGENIEURS Supported by the Chamber of Commerce and Industry of Rouen FRANCE APPLICATION FORM MASTER PROGRAM ACADEMIC YEAR / % MSc. Management of Electronic and Embedded Systems (MSEE) Session: ........................................ PhotographSurname: & & & & & & & & & & & & & & & & .. First name: & & & .& & & & & & & & & & & .& & Country: & & & ...& & & & & & & & & & & ....... Please return this application to: ESIGELEC/EIGSI/NBS - R枠 ^ ying. HYPERLINK "mailto:liu@esigelec.fr" \t "_parent" liu@esigelec.fr 5u輯15900817904 PERSONAL INFORMATION (to be completed by the applicant) Surname: & & & & & & & & & & & ........ Date of birth: & & & & & & & & & & & ... Sex: ............Nationality:& & & & & & .... Current address: & & & & & .& & & & & & & & & & & & . & & & & & & & & & & & & & 厖厖.. 厖厖厖厖厖厖厖厖.. First name(s): 厖厖厖厖厖厖.. City of birth: 厖厖厖厖厖.厖.... Nationality:............................................... Mobile:厖厖厖厖厖厖厖厖. Tel.: 厖厖厖厖厖厖厖. E-Mail :厖厖厖厖厖厖...LANGUAGES (to be completed by the applicant) Mother tongue: 厖厖厖厖厖厖厖厖厖厖厖厖厖厖厖厖 Language of instruction (if different from mother tongue): .............................................................LanguagesI am currently studying this languageI have sufficient knowledge to follow lecturesI plan to take some lessons before departure for France YesNoYesNoYesNo English French( (( (( (( (( (( (BACKGROUND (to be completed by the applicant) What is your current occupation (student, worker...):..........................厖厖厖厖 Total number of higher education study years prior to departure abroad: .......................... Complete name of the highest degree you will have before departure to France? ............................................................................................................................................ Name and city of the last university/school in which you have got (will get) this degree? ............................................................................................................................................. Do you already have a work experience? ( Yes ( No If yes, what was (is) your title?................................................................ If yes, what was (is) your domain of activity? ......................................... Did you already go abroad? ( Yes ( No If yes, when and where?.......................................................................... 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