<p> INTERNATIONAL PROGRAM : COMPUTER AIDED ENGINEERING AND DESIGN</p><p>STUDENT APPLICATION FORM PART 1</p><p>STUDENT INFORMATION </p><p>Last Name______First Names ______Gender ( M/F ) ______Date of birth ______Country of birth ______Nationality______Country of permanent residence ______</p><p>Permanent address Address for correspondence if different ______Telephone ______Telephone ______email______email ______</p><p>Disability : Yes  No  If yes, please indicate the nature of your disability : ______</p><p>HOME INSTITUTION </p><p>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</p><p>Last Name______First Names ______Age ______Nationality______</p><p>EDUCATION</p><p>Secondary education Name of high school diploma (A level, Abitur, …): ______Year : ______</p><p>Higher education</p><p>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</p><p>Training in design : COURSE TITLE NUMBER OF YEAR LEVEL CREDITS (beginner/intermediate/ advanced)</p><p>Knowledge of software (i.e. MATLAB, CATIA, AUTOCAD, PROENGINEER, …)</p><p>NAME NUMBER OF LEVEL HOURS (beginner/intermediate/ advanced)</p><p>INDUSTRIAL EXPERIENCE (internships/placement/jobs)</p><p>COMPANY SECTOR SUBJECT/POSITION DATES (from… to …) COMPUTER LITERACY</p><p>Word</p><p>No knowledge  Beginner  Intermediate  Advanced </p><p>Excel</p><p>No knowledge  Beginner  Intermediate  Advanced </p><p>LANGUAGES</p><p>English Language Level</p><p>No knowledge  Beginner  Native  Intermediate  Advanced </p><p>TOEFL score (minimum : 530)/ TOEIC score (minimum : 750)/Cambridge : ______</p><p>French Language Level</p><p>No knowledge  Beginner  Native  Intermediate  Advanced </p><p>CHOICE OF PROJECT AT ESTACA</p><p>Aeronautics  Automobile </p><p>I certify that the information given in this application is true and complete.</p><p>Name : ______Signature : ______Date : ______</p><p>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].</p>