REGISTRATION FORM INNOV@INSA – SUMMER 2021

REGISTRATION FORM INNOV@INSA – SUMMER 2021

Choose your INNOV session : ☐from May 18^th to June 15^th ☐from June 18^th to July 16^th Only if you have selected the INNOV May-June session :

Choose your track : ☐Connected Devices and Smart Devices

 I fill in the Prerequisites for this track: Knowledge and experience in Algorithmics and programming language

☐Management & Innovation in Europe

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First Name : Enter text Gender: ☐Female Last Name : Enter text ☐Male Date of birth: Enter text Nationality: Enter text Country of birth: Enter text City of Birth : Enter text Phone number: Enter text Email address: Enter text Disabilities: ☐ No ☐ Yes ^{Enter text}

Allergies: ☐ No ☐ Yes Enter text

Sending Institution / University : Enter text

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Address : Enter text

Country : Enter text City / zip code : Enter text

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First Name : Enter text Phone number Enter text

Last Name : Enter text

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Highest degree obtained / Level : Enter text Year : Enter text Name of the University : Enter text

End of Highshool studies or baccalaureate (year) : Enter text Name of Highschool : Enter text

Academic level: ☐Bachelor (3 years program)

☐Master of Science/Master of Engineering ☐Bachelor of Honor (4 years)

☐Engineering school (5 years program) year (1 to 5) : Enter text

☐ Other (please precise) : Enter text

Level of French : ☐Beginner ☐Intermediate ☐Advanced

To Apply to the INNOV@INSA Program, please remember to also send us a cover letter, and a resume before April 5^th for the May-June session, and before April 23^rd for the June-July session.

COVID19 : You can refer to the Rules and Regulations on the Program’s webpage for more information regarding the organisation of the program on site in light of the health protocols.

If you have any questions regarding the summer school, please contact Tara PIGNAL, coordinator for short Programs :

- [email protected] for the May-June session - [email protected] for the June-July session