Application for:
Master in Computer Science

Intelligent and Autonomous Interactive Systems (SIIA) 

First Name:
Last Name:
Date and place of birth:
Social Security Number:
Familial Situation:
Address, Street, Postal Code, City and Country:

Email(s):
Phone/Mobile Number (inc. area code if not in France):

For French applicants
Baccalauréat, série, year and mention: 
I.N.E number:

For applicants from other countries
Are you applying for the Master by Research : yes/no
If yes, name and contact email of the researcher sponsoring your research project:

Higher Education (add rows if necessary):
Year	Diploma	Mention/Achievement/Ranking	Institution	City	

					

					

Date of first registration at ENIB, for existing ENIB students:

Internships description
for each internship, placement or other industrial/research lab experience, give:  dates, location, institution/company, and a couple of sentences to describe the experience.

Languages proficiency 
(native, fluent, working professional, limited working proficiency, elementary profiency) :
French:
English:
Other (please specify):

Please:
•	-	 have the next section filled by your last English Teacher if you are a current ENIB student
•	-	alternatively provide an English certification score/result.

According to your expertise, the applicant (please strike through when irrelevant):
•	-	Will easily reach the required level requested at ENIB.
•	-	Should obtain this level provided regular work.
•	-	Will have difficulty reaching this level in the absence of intensive work or linguistic stay overseas.

Name and Signature of the English Teacher:

Emergency contact
Name, Address:
Phone/mobile number:

Date and Signature of the applicant:

The full application file is composed of:
•	-	The present form, filled.
•	-	A Letter of Motivation.
Please send the application electronically 
•	-	To scolarite@enib.fr
•	-	With the subject “Master SIIA ENIB Application”
Upon reception, you should receive an email acknowledgement in a couple of days.