APPLICATION FORM
INSTITUTIONAL FINANCING
CANDIDATE
Title :  Mr
 Mrs
SURNAME (maiden name for married women):
USUAL NAME (married name for married women):
First name:
National insurance number: ___| ______| ______ |______| _________ _________ ______
Date of birth: |__|__| |__|__| |__|__||__|__|
Place of birth: Town:
______________
Country: _ _ _ _ _ _ _ _ _
Nationality:
Marital Status :
single  married  widowed  divorced  partner
separated partner in a civil solidarity pact
Number of children: |__|__|
Address:
postal code:
Telephone number:
Email:
Town :
Professional situation:
Are you in a position of civil servant:  YES
 NO
If you are concerned, are you  trainee  permanent employee
Detail your civil servant degree: _ _ _ _ _ _ _ _ _ _ _ _ _ _ place of nomination _ _ _ _ _ _ _ _ _
Do you have the aggregation:  YES
 NO
If you do, point out the wording and year:
PREVIOUS TRAINING
Bac + 5 years of further education diploma:
Country where you got it:
School of education:
Date of getting:
Speciality of your diploma:
 Master
 Engineer
 other, tell precisely:
Do you have the aggregation: YES  NO
Are you a former student from a National Institute: YES, point out which one _ _ _ _ _ _ _ _ _
Distinction:  congratulation  Very good  Good  Quite good  Only average
 NO
THESIS
Doctoral Schools :
 n°521 Information Science and Engineering
 n°522 Materiels, Mechanical, Energy and
Aeronautical Science and Engineering
 n°523 Enviromental Sciences « Gay Lussac »
 n°524 Biology and health Sciences « Biohealth »
Research unit:
Title of the thesis:
PhD supervisor:
 Mr  Mrs
Surname:
Firstname :
CNU section: _________
Research Unit:
 n°88 Law and Political Science « Pierre Couvrat »
 n°525 Letters, Thought, arts and history « Civilization and
Literature from Antiquity to today »
 n°526 Societies and Organisations
 n°527 Cognition, Behavior, language(s)
If there is a joint advisor, detail for each one:
 Mr  Mrs
Surname:
Name:
Authorization to direct researches:  Yes
CNU Section: _________
Research Unit:
 Mr  Mrs
Surname:
Name:
Authorization to direct researches:  Yes
CNU Section: _________
Research Unit:
 No
Kind of financing wishes:
 PhD Contract
 regional grant (you can check both financing propositions if you are interested by each one)
Would you like to be sessional lecturer:  YES
 NO
PAPERS TO JOIN with this application form :
 Curriculum Vitae,
 Cover letter with professional plan,
 copy of Master report card and of certificate of achievement,
 thesis project (between 3 et 4 pages),
 one page popularized summary of your thesis project in French
 substantiated recommendation from the PhD supervisor to give you a financial support
 copy of an ID card
These documents have to be return by email at recrutement-edts@unilim.fr
not later than the June, 11th 2014.
Contact : Claire BUISSON
Université de Limoges – Pôle Recherche - Collège Doctoral
33 rue François Mitterrand - BP 23204 - 87032 Limoges
 : 05 87 50 68 92 Fax : 05 55 14 91 08
claire.buisson@unilim.fr
 No