SUPPLIER Pre-Qualification Questionnaire
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Master of Science Urban Agriculture & Green Cities Page 2/7 2b/ Please give details of the aspects of your studies that are most relevant to this Master’s program How does this Master’s
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Master of Science Urban Agriculture & Green CitiesPage 1/7 Last name: Fi rst name:
Your current situation:
1/ Please give your two main reasons for wishing to be considered for the Master's program in Urban Agriculture & Green
Cities.
2a/ Please describe the milestones in your career to date, and say how this Master's degree qualification fits into your future
career plan.Motivation QUESTIONNAIRE
MSc - Master of Science Urban Agriculture & Green CitiesMaster of Science Urban Agriculture & Green CitiesPage 2/7 2b/ Please give details of the aspects of your studies that are most relevant to this Master's program. How does this Master's
degree qualification fit into your career plan?3/ What type of job do you envisage for yourself later on?
4/ Which companies would you like to work for? Please explain why.
5/ If you are not a French national, do you know of any French companies operating in your country of origin? (Please list
them.)Master of Science Urban Agriculture & Green CitiesPage 3/7 6/ How did you hear of this Master's program?
7/ Are you considering any other study programs? If so, please give details.
Master of Science Urban Agriculture & Green CitiesPage 4/7 For your application to be complete, you must also submit: (min TOEIC 785 points or min BULATS 70 points TOEFL Ibt 80TOEFL Pbt 503) (
Except for students from English-speaking countries) (mandatory for both students and people in employment) - translated into French or English Ö Applications and all accompanying documents should be returned: via email to: celine.jacquemoire@unilasalle.fr or by post to: UniLaSalle RouenService Admission
3, rue de Tronquet
76130, Mont Saint Aignan
France
Application deadlines:
September 11
s t 20 20Please allow enough time to obtain your visa, if applicable. You should make the relevant enquiries with the authorities concerned
(for example Campus France).UniLaSalle is happy to provide any documents you may need to complete your visa application (proof of address, certificate of pre-
enrolment, etc.).IMPORTANT:
Does your current situation allow you to undertake UniLaSalle program fees? (registration fees for 18 months approx. 8,200 € ;
yearly living expenses in France 7,400 € minimum)YES / NO
Did you start to prepare your file for scholarship application?YES / NO
If yes, which scholarship application did you apply for?We require you to have adequate insurance cover for your journey and any repatriation, hospitalization and medical
expenses, at least for your first month of attendance at UniLaSalle, and to take out civil liability insurance.
Application form
MSc Urban Agriculture & Green Cities
Master of Science Urban Agriculture & Green CitiesPage 5/7YOUR DETAILS
Please write clearly and legibly.
Title: Mr Mrs
FAMILY NAME (in block capitals): ......................................................................................................................................................................
GIVEN NAMES: .........................................................................................................................................................................................................
Email: ...........................................................................................................................................................................................................................
Higher education qualifications awarded + specialisms / continuing educationGrade/Class: .......................................................................................................................................................................
Current course of study / continuing education: ...............................................................................................................
Institution attended: ..........................................................................................................................................................
RESIDENTIAL ADDRESS:
Road name and number: ....................................................................................................................................................
Zip code:
............................................ ........................... Town/City: ................................................................................................
Landline: + ............................................................. COUNTRY: ...................................................................................
Mobile: + ......................................................................Date of birth (dd/mm/yy): ___ / ___ / ___
Place of birth: ............................................................... COUNTRY: ...................................................................................
Nationality: ................................................................... Marital status: .............................................................Professional Referees (if applicable):
Employer: ...........................................................................................................................................................................
Address: ..............................................................................................................................................................................
Zip code: ............................................ ........................... Town/City: ................................................................................................
Landline: + ............................................................. COUNTRY: ...................................................................................
Mobile: + ......................................................................ADDITIONAL INFORMATION:
Do you hold a valid driving licence? Yes ܆ No ܆If so, length of time held and vehicle category entitlements: ...........................................................................................
Sport(s) played: ...................................................................................................................................................................
Leisure activities: ................................................................................................................................................................
Master of Science Urban Agriculture & Green CitiesPage 6/7 How do you intend to finance your studies?
Have you already researched the grants available? If so, give details? Higher education / continuing education (please fill in carefully and give precise details):