UNIVERSITÉ DE MAROUA / THE UNIVERSITY OF MAROUA FACULTÉ DES MINES ET DES INDUSTRIES PETROLIÈRES FACULTY OF MINES AND PETROLEUM INDUSTRIES
FICHE D'INSCRIPTION AU CONCOURS D'ENTRÉE EN 3ᵉ ANNÉE DU CYCLE D'INGÉNIEURS DE CONCEPTION EN TROIS ANS SESSION DU 09 SEPTEMBRE 2018
REGISTRATION FORM FOR THE COMPETITIVE ENTRANCE EXAMINATION INTO THE 3ᵗʰ YEAR OF THE MASTERS IN ENGINEERING DEGREE SESSION OF 09ᵗʰ SEPTEMBER 2018
(Toute information fausse entraînera l'élimination immédiate du candidat) (Any false information will lead to immediate disqualification of the candidate)
Session Session
Centre du concours Examination centre
Spécialité sollicitée Speciality desired
Jour Mois Année [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Filière/Serie [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Parcours/Specialisation [ ] [ ] [ ] [ ]
(Centres de concours : Bambili, Buea, Douala, Dschang, Kaélé, Maroua, Ngaoundéré et Yaoundé 1)
Admission : Sur concours/On competition ☐ Cycle/Cycle : Ingénieur de Conception (03 ans) Master in Engineering degree (03 years)
Sur étude de dossier/On study of file ☐
DIPICOME D'ENTRÉE/ ENTRANCE CERTIFICATE
Titre Title [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Série Option [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Année d'obtention Year of obtention [ ] [ ] [ ] [ ]
ETAT CIVIL DU CANDIDAT/CIVIL STATUS OF THE CANDIDATE
NOMS (En majuscules)/SURNAMES (In capital letters) [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
PRENOMS (En majuscules)/FIRST NAMES (In capital letters) [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Date de naissance/Date of Birth Jour/Day Mois/Month Année/year [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Lieu de naissance/Place of Birth [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Région d'origine/Region of origin [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]
Département d'origine/Division of origin