Estaca International Program

INTERNATIONAL PROGRAM : COMPUTER AIDED ENGINEERING AND DESIGN

STUDENT APPLICATION FORM PART 1

STUDENT INFORMATION

Last Name______First Names ______Gender ( M/F ) ______Date of birth ______Country of birth ______Nationality______Country of permanent residence ______

Permanent address Address for correspondence if different ______Telephone ______Telephone ______email______email ______

Disability : Yes  No  If yes, please indicate the nature of your disability : ______

HOME INSTITUTION

University : ______International Coordinator (name, title) :______Address : ______Telephone : ______Fax :______email : ______Field of study at home institution : ______INTERNATIONAL PROGRAM : COMPUTER AIDED ENGINEERING AND DESIGN STUDENT APPLICATION FORM PART 2

Last Name______First Names ______Age ______Nationality______

EDUCATION

Secondary education Name of high school diploma (A level, Abitur, …): ______Year : ______

Higher education

YEAR UNIVERSITY MAIN FIELD YEAR MAIN COURSES (indicate your DIPLOMA/ (name + OF STUDY : OF majors among) : DEGREE country) - automotive STUDY - mechanical engineering OBTAINED - mechanical (1rst/ (solid, fluid) - aerospace 2nd,…) - heat transfer - industrial - electronics - electrical/ - project management - manufacturing management electronical - marketing - other (specify) 2005- 2006 2004- 2005 2003- 2004 2002- 2003 2001- 2002 2000- 2001

Training in design : COURSE TITLE NUMBER OF YEAR LEVEL CREDITS (beginner/intermediate/ advanced)

Knowledge of software (i.e. MATLAB, CATIA, AUTOCAD, PROENGINEER, …)

NAME NUMBER OF LEVEL HOURS (beginner/intermediate/ advanced)

INDUSTRIAL EXPERIENCE (internships/placement/jobs)

COMPANY SECTOR SUBJECT/POSITION DATES (from… to …) COMPUTER LITERACY

No knowledge  Beginner  Intermediate  Advanced 

LANGUAGES

English Language Level

No knowledge  Beginner  Native  Intermediate  Advanced 

TOEFL score (minimum : 530)/ TOEIC score (minimum : 750)/Cambridge : ______

French Language Level

No knowledge  Beginner  Native  Intermediate  Advanced 

CHOICE OF PROJECT AT ESTACA

Aeronautics  Automobile 

I certify that the information given in this application is true and complete.

Name : ______Signature : ______Date : ______

This application form must be returned before November 30th, 2005 to : ESTACA, Farida Chabouni-Gabard, International Exchange Programs Coordinator, 34-36 rue Victor Hugo, 92300 Levallois Perret, France, or by fax : +33 1 41 27 60 25. Email : [email protected].