APPLICATION FORM
Master of Science and Engineering (MSE)
SMART CITIES
Academic year 2016-2017 – Lille (France)
This form must be fully completed and sent as soon as possible to master-smartcities@hei.fr
Application is free of charge – The application deadline is April 27 th 2016
Minimum academic degree requirements include an awarded relevant Bachelor Degrees (or
equivalent) for International students and an awarded “License” (or equivalent) for French students.
Pending diplomas may also be considered.
Please also note that undergraduates with commensurate capacity or professional background in the
fields of Energy, Environment or Habitat including Civil Engineering or Architecture, will also be
considered for admission.
Upon examination by a qualified jury you will receive timely notification of results. Pre-selected
candidates will participate during June/July in a distance-examination session including
Scientific/Technical Competence, General Background and Language.
Please note that only properly completed application forms will be examined by the jury.
More information is available on www.hei.fr and www.hei.fr/formations/mse-smart-cities
For further Information please send enquiries to master-smartcities@hei.fr
Master of Science and Engineering SMART CITIES - APPLICATION FORM - SECTION 1/3
Section 1 - General Information
CANDIDATE INFORMATION
Family name
Given names
Date of birth
Nationality
Married
Place of birth
dd/mm/yyyy
Gender M
YES
NO
Country
F
If YES, Maiden name
POSTAL ADDRESS
Street
Building number
City
Postal code
State
Country
CONTACTS
Phone number (with international area code)
Mobile phone (with international area code)
E-mail
Application Form sections 1 to 3 must be completed, scanned and sent by email to:
master-smartcities@hei.fr
Master of Science and Engineering SMART CITIES - APPLICATION FORM - SECTION 2/3
Section 2 – Studies and Motivation Information
Family name
Surname
Higher education (including current Education background)
Academic year
Academic program
College / University / City / Country
Diplomas Granted
Level
Tittle / University / Country
Honors
Year of completion
Work experience (internships, jobs …)
From (date)
To (date)
Position and mission
Country
Language proficiency
Language
English
French
Level
Excellent
Good
Medium
Low
Test taken (TOEFL, DELF, IELTS….)
Excellent
Good
Medium
Low
Excellent
Good
Medium
Low
Excellent
Good
Medium
Low
Overall score
No knowledge
Please explain here below your main motivations for the Master of Science and Engineering
SMART CITIES and how it will further your career goals (max 15 lines).
Application Form sections 1 to 3 must be completed, scanned and sent by email to:
master-smartcities@hei.fr
Master of Science and Engineering SMART CITIES - APPLICATION FORM - SECTION 3/3
Section 3 – Supporting documents
Family name
Surname
To complete application the following documents must be sent (PDF file format) and
received by April 27, 2016 to: master-smartcities@hei.fr
Documents to enclose
1. Copy of passport or National ID (in English or French)
2. Digital Photo (standard passport size – JPEG file format)
3. CV with Photo
4. Copies of Transcripts of records of all Academic Training, including current year
5. Copies of awarded Diplomas
6. Copy of English Proficiency certificate
7. Copy of French Proficiency certificate
8. Option: Letter(s) of Recommendation from Professors, Administrators and Employers
Administration use
- received
- received
- received
- received
- received
- received
- received
- received
Please fill in the following section before sending your Application Form:
I, ………………………………………………………………………………………, the undersigned (Family Name – First name) hereby certify
that this attestation and all provided information is true and accurate to the best of my knowledge, and thus confirm
my application to the Master of Science and Engineering SMART CITIES for the academic year 2016-2017.
In place _______________________________
Date
_______________________________
Signature :
__________________
Application Form sections 1 to 3 must be completed, scanned and sent by email to:
master-smartcities@hei.fr