Université Sorbonne Paris Cité
International Scholarship Programme MIEM
Application Form 2016 / 2017
GENERAL CONDITIONS :
- Eligible Training at MIEM scholarship program:
- Engineers Training SupGalilée
- Master COLEDI: Language Sciences, contrastive specialty, vocabulary, speech
- Master EPOG: Economic Policies in the Age of Globalisation
- Master Mathematics, Basic Mathematics specialty
- Master MOSS: Management of health and social organizations
- The amount of the scholarship MIEM is 10 000 € for a period of one year.
- It is your responsibility to check that the file is completed with all attached documents.
- Lack of supporting documents or non-compliance of the internal policy of the University Paris 13 implies
the automatic refund of any scholarship.
Documents to complete the application:








This application form
Your complete and up to date curriculum vitae
Courses attended and transcripts for the past three academic years, including the current year copies
of your diplomas (NB: selected students will be asked to bring the original diplomas on arrival).
Language certificate.
Two letters of reference from academic or research staff, of which at least one belongs to your home
university, with their exact and complete contact details (see annex 1).
Registration certificate for 2013-2014 (if presently enrolled in a higher education institution).
A photocopy of your passport.
An education plan for Master or PHD degree (see annex 2)
Submission of applications:
The complete application files, containing this application form and the complementary documents, are to
be sent in a single .pdf file to the International and European Relations Office (SREI)
Deadline: May 2, 2016. Incomplete applications will not be processed.
Contact: Emmanuel BENOIT - [email protected]
Université Sorbonne Paris Cité
1/7
Information concerning the applicant
PERSONAL INFORMATION:
Gender:
F
M
Last name: _________________________________________________________________________________________
First name: _________________________________________________________________________________________
Date of birth: ___ / ___ / _______ Place of birth: _____________________ Nationality: ___________________________
Mailing Address for correspondence: ___________________________________________________________________
Post code: ________________ City: ___________________________ Country: _________________________________
Phone number: ____________________________________ Mobile number:___________________________________
E-mail address: ______________________________________________________________________________________
ACADEMIC RECORD
Home institution name: _______________________________________________________________________________
Department/Faculty: _________________________________________________________________________________
Address: ___________________________________________________________________________________________
___________________________________________________________________________________________________
Phone number: ________________________________ E-mail address: _______________________________________
Website: ___________________________________________________________________________________________
Detail your education during the last 4 years. Include details of qualifications to be awarded:
College / University /
Awarding body/Country/City
Name of unit
Main subject(s)
studied
Degree/Diploma
obtained/date of
award
Marks
Rank*
2014-2015
...
...
...
...
…
…
2013-2014
...
...
...
...
…
…
2012-2013
...
...
...
...
…
…
2011-2012
...
...
...
...
…
…
* For instance 3rd out of 58, or ranked 5%, etc
Université Sorbonne Paris Cité
2/7
Please explain the grading system (for instance A,B, C…, A being the highest mark)
..................................................................................................................................................................................................................
..................................................................................................................................................................................................................
..................................................................................................................................................................................................................
..................................................................................................................................................................................................................
LANGUAGE SKILLS:
Your level of competence in French and English:
French
English
Spoken ability:
A1/A2
B1/B2
C1/C2
A1/A2
B1/B2
C1/C2
Written ability:
A1/A2
B1/B2
C1/C2
A1/A2
B1/B2
C1/C2
French certificate:
Yes
No
If yes, please include it in your application documents (DELF, DALF, TCF, TEF)
English test:
Yes
No
If yes, please include it in your application documents (TOEFL, IELTS)
Do you intend to take French language courses at Paris 13 ?
YES
NO
INFORMATION ABOUT YOUR PERIOD OF STAY AT PARIS 13:
Graduate level at Paris 13 in 2015/2016:
Master 1
Master 2
Master attended at Paris 13 (full name): ______________________________________________________________
___________________________________________________________________________________________________
Planned period of the mobility:
From :
______ / ______ / __________
Till :
______ / ______ / __________
Université Sorbonne Paris Cité
3/7
APPLICANTS’ DECLARATION:
I hereby certify that the information contained in this application is accurate and complete.
Place __________________ , date ___________
Applicant’s signature preceded by the
handwritten words « lu et approuvé »
Service des Relations Européennes et Internationales
Programme de bourses MIEM :
Université Paris 13 – Bâtiment de l’IUT – Bureau L101
99, avenue Jean-Baptiste Clément
93430 Villetaneuse
Contact : [email protected] ; Fax : + 33 (0) 1 49 40 39 22
Université Sorbonne Paris Cité
4/7
ANNEX 1:
REFEREES
Please indicate at least 2 academics of which at least one from your home institution that may provide references for
your application:
1. Name and position: ..............................................................................................................................................................................
..................................................................................................................................................................................................................
Address: ...................................................................................................................................................................................................
..................................................................................................................................................................................................................
Phone number: ............................................................... Fax number: .................................................................................................
E-mail address: ................................................................ Website: .......................................................................................................
2. Name and position: ..............................................................................................................................................................................
..................................................................................................................................................................................................................
Address: ...................................................................................................................................................................................................
..................................................................................................................................................................................................................
Phone number: ............................................................... Fax number: .................................................................................................
E-mail address: ................................................................ Website: .......................................................................................................
Université Sorbonne Paris Cité
5/7
ANNEX 2:
EDUCATION PLAN
Writing about your education plan
Why did you choose France for your studies? Please explain what aspects of the selected master’s
programme are most appealing to you.
After your master’s studies do you plan to undertake a PhD thesis?
Yes
No
If yes, please give some more details about your plans: ...................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
If not, what are your future career plans? : ........................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
Université Sorbonne Paris Cité
6/7
Have you already defined the research topic for your Master internship?
Yes
No yet
If yes, please detail your research interests (max. 1 page).
Please explain how this master programme at Paris 13 and your previous studies could help you to achieve
your goals.
Université Sorbonne Paris Cité
7/7