SMART CITIES
SUMMER SCHOOL
2020
APPLICATION FORM
· Please fill out your application form using a computer
PERSONAL DETAILS
First name(s) as on passport: Please fill in
Family name(s) as on passport: Please fill in
Date of birth (dd/mm/yyyy): Please fill in
Place of birth: Please fill in
Citizenship: Please fill in
Gender: M ☐ F ☐
Address: Please fill in
Zip code, city, state: Please fill in
Country: Please fill in
Phone: Please fill in
E-mail: Please fill in
Skype: Please fill in
Home University: Please fill in
Contact in case of emergency
Name: Please fill in
Address: Please fill in
Phone: Please fill in
E-mail: Please fill in
EDUCATION
Academic year
Academic institution
Degree subject
Please fill inPlease fill inPlease fill inPlease fill inPlease
fill inPlease fill inPlease fill inPlease fill inPlease fill
inPlease fill inPlease fill inPlease fill inPlease fill inPlease
fill inPlease fill in
LANGUAGES
Level
Certificate (TOEFL, IELTS, DELF, TCF, BULATS…)
Score
English
Excellent ☐ Good ☐ Medium ☐ Low ☐
Please fill inPlease fill in
French
Excellent ☐ Good ☐ Medium ☐ Low ☐ No knowledge ☐
Please fill inPlease fill in
Other
Excellent ☐ Good ☐ Medium ☐ Low ☐
Please fill inPlease fill in
Other
Excellent ☐ Good ☐ Medium ☐ Low ☐
Please fill inPlease fill in
WORK EXPERIENCE
From
To
Position and mission
Country
DateDatePlease fill inPlease fill inDateDatePlease fill inPlease
fill inDateDatePlease fill inPlease fill inDateDatePlease fill
inPlease fill in
MOTIVATIONS
Please describe in 500 words, on a separate attachment in Word
format, your main motivations for the SMART CITIES Summer School in
terms of :
· Interest in Smart Cities
· Added value for your professional career
Date
Choose date
Signature
SUBMISSION
SUPPORTING DOCUMENTS
☐ Copy of passport or National ID
☐ Digital passport-size photo (.jpeg)
☐ Motivation letter
Please return this form with supporting documents to
[email protected] before :
26th April 2020
