IIT-ParisTech - Internships - Application Form 2011

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					                                 IITs-ParisTech Fund for Science & Technology
                                        Internship Programme - Scholarships
                                 Application Form for IIT and ParisTech students
Last name                               First Name                 Date of birth          Nationality             Female/Male

School at ParisTech or IIT                                         Degree program in which you are currently enrolled

Your equivalent level of studies                                   Major
(indicate number of years in the program)

Bachelor    –      Master    –    PhD
Correspondence address


Intended period of stay at host institution

from:_________________________________________ / until: _________________________________________

IITs-ParisTech Fund priority area

Information Technology and Electrical Engineering – Applied Mathematics – Fluid and Solid Mechanics – Chemistry – Materials Science

Topics of the research project

Host Institution

Host Laboratory

Name of the supervisor at host institution
Email address of the supervisor at host institution
Name of the supervisor at home institution
Email address of the supervisor at home institution
If you apply for other sources for this stay, please
mention them

IMPORTANT - Please send by email the following documents (pdf format) to the following address
by April 15, 2011:

Documents to be included in the application:
1) This completed application form
2) A letter of motivation, detailing your topics of interest and potential host laboratories
3) A transcript of your academic results in the current and past two semesters at least.
4) The attached recommendation form, completed by the professor acting as your tutor or supervisor in your
home institution
5) The agreement email by the academic supervisor at the partner institution
6) A letter from the professor explaining the research collaborations that your stay can help to develop
For further information:

IITs-ParisTech Fund                                                   Internship Programme
for Science & Technology                                                       Scholarships

                                Lettre confidentielle / Confidential letter

The recommendation form must be completed, signed, scanned and sent by e-mail to:

                                                 Candidat / Candidate
                         Nom / Family Name
                     Prénom / Given Name
           Date de naissance / Date of Birth

                                                 Evaluateur / Referee
                         Nom / Family Name
                      Prénom / Given Name
                      Titre / Current position
Université ou établissement d’enseignement
            supérieur / University or College
                  Département / Department
                                    Adresse /
                     Current mailing address
                 Téléphone / Phone number
               Adresse électronique / E-mail

      A quel titre avez-vous connu le candidat (enseignant, tuteur, etc.) ? /
 In what capacity have you known the applicant (teacher, supervisor, etc.)?
               Pendant combien de temps avez-vous connu le candidat ? /
                                How long have you known the candidate?
Evaluation / Ratings
Par comparaison avec les autres étudiants du même niveau universitaire, indiquer comment le candidat se situe au niveau de ses résultats académiques et de sa
personnalité. / Compared to other students whom you have taught, check how you would rate this student in terms of academic skills and potential.
Cochez une case et une seule par ligne horizontale. / Tick only one box on each horizontal line.

                                                                                                                                                            En dessous de la Observation
                                           Très exceptionnel /   Exceptionnel   / Excellent /       Très Bon /                               Moyens /
                                                                                                                         Bon / Good                         moyenne /        s’avérant
                                           Truly Exceptional     Exceptional      Outstanding       Very good                                Middle
                                                                                                                                                            Below average    impossible /

                                           Premiers 1% / Top Premiers 3% / Top Premiers     10%   / Premiers     25%   / Premiers     40%   / Moyens 20%   / Derniers 40%   / No opportunity to
                                           1%                3%                Top 10%              Top 25%              Top 40%              Middle 20%     Lowest 40%       observe

            Résultats académiques/
            Academic achievement
                 Capacité de travail /
                     Working ability
           Capacités intellectuelles /
                   Intellectual ability
              Originalité, créativité /
           Creative, original thought
      Aptitude à l’interdisciplinarité /
               Interdisciplinary skills
           Jugement, sens critique /
           Judgement, critical sense
                         Adaptabilité /
                  Expression écrite /
                  Written expression
                   Expression orale /
                     Oral expression
          Aptitude à communiquer /
               Communication skills
                 Évaluation globale /
                  Overall evaluation

                            Appréciation personnelle / Personal evaluation

Le comité de sélection souhaite connaître votre avis sur les aptitudes du candidat ainsi que sur ses
points forts et faibles. Le jury est particulièrement intéressé par votre appréciation sur ses capacités
intellectuelles, sa capacité d’abstraction, sa motivation, sa maturité, sa créativité, son initiative et son
projet professionnel.

En plus des qualités personnelles du candidat, le jury souhaite connaître les liens scientifiques existants
et/ou qui pourraient être développés entre les deux laboratoires (celui d’origine et celui d’accueil).

The selection committee will appreciate your opinion of the applicant's ability and your comments on
his/her strengths and weaknesses. The jury is particularly interested in the candidate’s intellectual
promise, his/her ease in abstract reasoning, motivation, relative maturity, creative thought, potential,
capacity for growth, initiative and future plan of career.

In addition, the jury would like to know if there are any existing scientific relations or if any cooperation
could be developed between the home institute and the host laboratory.

      Nom de l’évaluateur / Referee’s name


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