邢唷 > 欹 #` bjbjm -B ~ % h h h | D D D 8 | 4 | . . H " " " " G. I. I. I. I. I. I. / h :2 ` I. h € { " € € I. " " Y ^. € " h " G. € G. ) ^ h '- " < `崳$g D , P #. $ t. 0 . , P 2 2 '- 2 h '- " I. I. j . € € € € | | | € | | | € | | | Master-PhD Program Co-operation program between CSC and French UT APPLICATION FORM administrative information Academic Year 2011-2012 __________________________________________________________________________________________________________ 1 - Fill in all sections in English : First Name and Last Name: 厖厖 / 厖厖厖厖. Gender Male FORMCHECKBOX Female FORMCHECKBOX Date of birth: day/month/year: 厖. / 厖. / 厖........... Place of birth: 厖厖厖厖厖厖厖厖厖.......... phones number: 厖厖厖厖厖 / 厖厖厖厖厖厖 E-mail: 厖厖厖厖厖 /厖厖厖厖厖厖厖. Speciality: 厖厖厖厖厖厖厖厖厖厖厖厖厖厖厖 School: 厖厖厖厖厖厖厖厖厖厖厖厖厖厖厖厖. University: 厖厖厖厖厖厖厖厖厖厖厖厖厖厖厖 Degree or Diploma under preparation: 厖厖厖厖厖厖厖厖 Probable date of graduation: 厖厖厖厖厖厖厖厖厖厖 Foreign languages (please assess your ability according to the following grades: A- Excellent; B- Good; C- Average; D-weak) Language 1: 厖厖 Reading grade: 厖 Writing grade: 厖 Oral grade: 厖 Language 2: 厖厖 Reading grade: 厖 Writing grade: 厖 Oral grade: 厖 Language 3: 厖厖 Reading grade: 厖 Writing grade: 厖 Oral grade: 厖 2 Please rank specialties (from 1 to a maximum of 3) you would choose for your Master抯 degree FORMCHECKBOX Optics and Nanotechnology (ONT) of UTT FORMCHECKBOX Systems Optimization and Security (OSS) of UTT FORMCHECKBOX Information Technologies for the Management of Knowledge and Networks (TICOR) of UTT FORMCHECKBOX Mechanical Systems and Materials (SMM) of UTT FORMCHECKBOX Biotechnologies: Implementing Biological Functions (BFB) of UTC FORMCHECKBOX Formulated Products Engineering (GPF) of UTC FORMCHECKBOX Sustainable Technologies (TD) of UTC FORMCHECKBOX Elaboration of Innovative and Sustainable Structures (ESID) of UTC FORMCHECKBOX Mechatronic Systems (SYM) of UTC FORMCHECKBOX Science and Technology in the Health Sector (STS) of UTC FORMCHECKBOX Innovation, Knowledge, Interaction (ICI) of UTC FORMCHECKBOX Intelligent Systems for Transport (SIT) of UTC FORMCHECKBOX Algorithmics: High Performances and Modelling (AHPM) of UTBM 3 Please explain your choice here This document must be given to the jury at the beginning of the interview, with your transcripts and recommendation letters PAGE PAGE 1 PICTURE ' ( V W 糸拗死瘽俫Q8 1hiH h B* CJ OJ QJ ^J aJ mH ph 3f sH +h8F@ B* CJ OJ QJ ^J aJ mH ph 3f sH 4h8F@ h 5丅* CJ( OJ QJ ^J aJ( mH ph 3f sH 4h8F@ h8F@ 5丅* CJ( OJ QJ ^J aJ( mH ph 3f sH #h;| h3<