ÉCOLE POLYTECHNIQUE EXECUTIVE MASTER Application Form Please return the completed application file and any required documents to the following address: executive.master@polytechnique.fr ECOLE POLYTECHNIQUE EXECUTIVE EDUCATION ROUTE DE SACLAY, 91128 PALAISEAU CEDEX - www.exed.polytechnique.edu
Admissions Process: Those wishing to discuss their profile before applying are encouraged to request a telephone interview (optional) Complete and return the application before the deadline After validation of your completed application, a pre-selection will be made by the Selection Committee and selected candidates will be invited for an interview. The Admission Jury will be held for final selection. These juries are held approximately every 3 months. An official letter of acceptance or non-acceptance will be sent within a week of the Admission Jury. For those admitted into the program, a non-refundable deposit of 2 000 will be required in order to secure your place. You will receive an invoice by email within 15 days after admission to the program and must be paid within 30 days of reception. Failure to pay this in time may result in your offer being withdrawn. Documents to provide: Copy of your ID card or passport Copy of all diplomas obtained (including a certified copy of the transcript of records). If the original is not in English or French, please also attach a certified translation of the degree and transcript. Copy of any professional certifications achieved. A recent headshot photo for professional use (minimum 300 dpi.jpg file). It will be published on the program website, if you are accepted. Non-native English speakers who do not hold a university degree from a university where English is the teaching language must complete and send a copy of one of the following: Minimum TOEFL: 100 internet-based, 600 paper-based Minimum TOEIC: 340 Speaking & Writing and 850 Listening & Reading Minimum IELTS: 7.0, with a minimum of 6.5 on each part of the test Those wishing to submit other tests results (GMAT, TAGE MAGE, etc.) taken within the last 5 years are invited to do so. Three letters of recommendation. Two professional recommendations, including one from a superior, and one personal recommendation. Your application will only be completed upon receiving these letters. Curriculum Vitae Organizational Chart Letter of Company Support A non-refundable application fee of 200.
Application Details: Starting Year / Session: Contact information: Prefix: First (Given) name: Last (Family) name: Maiden name: Preferred name: Suffix: Other names used: Home Address: City: Postal code: State/Providence/Region/etc.: Country: Telephone number (including country code): Mobile number (including country code): Personal email: Personal information: Date of birth: Place and Country of birth: Primary nationality: Dual nationality: Native language: Other languages: A: Fluent B: Advanced C: Intermediate D: Novice Language Spoken Read Write
If English is not your native language or you do not have a university degree from an English speaking country, please provide your test results for one of the following. This test result must be provided before the start of the program, however it is not mandatory to apply. You may also request a waiver. Test results: TOEFL Date: Total Score: TOEIC Date: Total Score: IELTS Date: Total Score: Optional test results: GMAT Date: Total Score: TAGE MAGE Date: Total Score: Other: Date: Total Score: Have you lived abroad or had a stay of more than 3 months? If yes, please explain: Country Length of Stay Dates Reason Current situation: Employed Independent Unemployed Other: Marital status: Married Single Domestic Partner Children (number and ages): Extra-curricular Activities: Please list the business/professional/community organizations in which you are active. Please list any hobbies, sports and other leisure activities that you are interested in.
Company information: Company: Company address: City: Postal Code: State/Providence/Region/etc.: Country: Telephone number (including country code): Professional email: Please indicate parent corporation name and address if subsidiary, division, or affiliate: Functional Area Accounting/Auditing Consulting Engineering Finance General Management Human Resources Investment Logistics Marketing Product Management Purchasing Sales Public Relations Real Estate Research and Development Strategic Planning Management IT Systems Other: Industry Communication/Information Technology Consulting Services (Please specify): Health Services Financial Services Food/Beverage Services Other (Please specify): Government Law Manufacturing (Please specify): Non-profit Utilities (Please specify): Organization Chart Describe the organizational unit for which you are responsible and relate it to the total organization in terms of size, scope and autonomy of responsibility. What human resources, budget, and capital investment are you responsible for? To what position(s) do you report? Please enclose a description of your position.
Work Experience: Current situation: Employed Seeking employment Other: Consultant Independent Company (or previous employer): Current position (or last held position): Years of professional experience (excluding internships and volunteering): Years of managerial experience: Current department: Legal Production/Operations Purchasing/Distribution Human Resources General Services Information Systems Marketing/Sales Management/Strategy Finance Auditing/Consulting Research & Development Other: Remuneration (including salary, bonus and others): Under 30K 70K 99K 31K 50K 100 149K 51K 69K Over 150K Professional Experience Years of work experience (full-time after first degree): Briefly list your precedent positions: Company Industry Position Dates Country Describe any major reports, instructional materials, or manuals that you have prepared or any research, inventions, or other creative work
Management Background: What is your area of expertise? Please assess your proficiency in the following management areas: General Management Beginner Somewhat Proficient Intermediate Very Proficient Expert Organization Behavior Production Marketing Managerial Economics Accounting Quantitative Skills Manpower/Industrial Relations Finance Operations Research Policy Formulation Engineering Research and Development Project Management Technological Innovation Entrepreneurship Other:
Character Self-Assessment: Please rate yourself on the following dimensions: 1 being poor 10 being excellent Social Skills Self-awareness Self-control Motivation Empathy Teamwork Work Ethic Analytical Skills Interpersonal Skills Maturity Leadership Potential 1 2 3 4 5 6 7 8 9 10
Education: Last degree earned: Year obtained: Institution: Total number of years studied: Please list chronologically the institutions you have attended and the degrees earned: Institution Attendance dates Degree or Diploma earned Principle focus of studies (major) Country Language Professional Qualifications (e.g. CPA, CFA, CBP, Board, BSCP, ENV SP, etc.) Institution Qualification Description Year obtained Country Language Other education:
Motivation: This section will provide the admissions committee with a clearer picture of your motivation for pursuing the École polytechnique Executive Master at this time as what you hope to gain from the experience. At this time, which of the following career objectives best describes you? I am looking to advance within my company or industry, take on a senior role, role of CIO, CEO, CFO, CTO, etc. I am looking to change to a new employer (e.g. change function / industry / geography / level / combination) I am an entrepreneur and plan to use the École Polytechnique Executive Master to advance my business I plan to use the École polytechnique Executive Master to help start a business Other, please specify : Are you applying to other programs? If so, which programs and why? How did you hear about the École polytechnique Executive Master? École polytechnique alumni Education fair École polytechnique Exed alumni E-mailing École polytechnique staff Advertisement École polytechnique Executive Education staff Which publication? Your company Magazine/Newspaper Internet search Which publication? École polytechnique website Word of mouth École polytechnique Exed website Other:
Essays: Essays may be written in English or French 1) Why are you seeking an École polytechnique Executive Master from École polytechnique Executive Education and what unique knowledge and experiences do you hope to contribute to the program? (maximum 500 words)
2) What do you expect to accomplish through this Executive Master program? What learning experiences do you expect, and how would you apply them? What specific benefits do you anticipate? (maximum 500 words)
3) If there is any important information relevant to your candidacy you were unable to address elsewhere in the application, please share that information here. (maximum 500 words)
4) What are your career objectives for the next 5 years? (maximum 250 words)
5) Please select one of the two questions below. (maximum 500 words) A) Tell us about a time when you created a competitive advantage for your organization. Comment on the factors you considered and any barriers you encountered in the organizational culture. - or - B) Tell us about a time when you inspired others to achieve success in a complex situation, such as across cultures or regions or in an adverse situation.
6) Please select one of the two questions below. (maximum 500 words) A) Tell us about one of your initiatives that resulted in a lasting organizational change. - or - B) Tell us about one of your ideas or initiatives that faced healthy skepticism and what you did.
7) What are your major non-professional activities / accomplishments? (maximum 250 words)
Letter of Company Support: You are asked to provide a letter of company support (on company letter head) certifying that your employer will allow you to attend all classes, conferences and any organized events during the program. This letter is not required to provide details of financial support, if any. Financing and Sponsorship: Tuition Fees How do you plan on paying for this program? Your company Personal funds Loan Financing organization: Grant (please explain): Other: Sponsorship Full Sponsorship Partial Sponsorship ( % of the total program fees) Name: Title: Company: Address: Telephone: Email: Sponsor Organization Data Name of Organization: Sales: Net Assets: Number of Employees: Net Income: Number of Products: Number of Facilities:
Letter of Recommendation Information: Please indicate the names and contact information for your three recommenders: Direct Superior Prefix: First (Given) name: Last (Family) name: Company: Telephone number (including country code): Mobile number (including country code): Email address: Colleague Prefix: First (Given) name: Last (Family) name: Company: Telephone number (including country code): Mobile number (including country code): Email address: Personal (Family or Friend) Prefix: First (Given) name: Last (Family) name: Relation: Telephone number (including country code): Mobile number (including country code): Email address:
Tuition Tuition for the École polytechnique Executive Master includes all course materials, housing and meals for the three international modules, conferences and any organized social events or dinners. All transportation, lodging for the French based modules and free evening activities are at the expense of the candidate. Tuition is payable in two installments on acceptance into the program. The first installment must be paid before the start of the program. The second installment must be paid before the start of module 6 (the second international module). Declaration 1. I understand that attendance to all aspects of the program are mandatory and that I will be free of other duties on class days. I fully note that I may not be absent for any reason. 2. I accept to make all payments according to the scheduled payment plan mentioned in the contract and agree to make the following payments: 200 non-refundable application fee, 2000 non-refundable deposit is due within 30 days of accepting your offer to reserve your place in the program, 50% of the tuition (minus the deposit) before the start of the program and the remaining amount before module 6 of the program. 3. I acknowledge that my diploma will only be presented after having completed all payments and met the requirements demanded by the École polytechnique Executive Education. 4. I declare that all statements made in this application to the École polytechnique Executive Master are accurate and complete. I understand this information will be used in the admission decision process and that any misrepresentation will disqualify my application for admission and enrollment. 5. I authorize École polytechnique Executive Education to obtain any and all information about my candidature whether they be about my studies, employment, recommenders, etc. 6. I understand that, upon submitting this application, I authorize École polytechnique to use my data as part of my participant record. This data will be used for a number of academic and administrative purposes consistent with the mission of École polytechnique Executive Education, including academic advising, program planning and evaluation, checks for concurrent registration at other institutions, etc. Signature of the Applicant Signed at and Date