Executive education application form - Sciences Po

ApplicationForm>EXECUTIVE MASTERENERGY AND GLOBAL POLICIES09MFI02Please complete all sections of the application form in English in the spaces providedbefore adding any information if required.Personal informationPHOTOMr MsLast name ....................................................................................................................................................First names ..................................................................................................................................................Nationality ....................................................................................................................................................Date of birth (day/month/year) ..............................................................................................................................Marital status ................................................................................................................................................Mailing Address (please inform us of any change in address)Address ............................................................................................................................................................................................................................................................................................................................Phone ............................................................ Fax ........................................................................................Mobile ..........................................................................................................................................................E-mail ..........................................................................................................................................................Business Address (please inform us of any change in address)Company name and address ................................................................................................................................................................................................................................................................................................Present position and title ................................................................................................................................Functionnal area ............................................................................................................................................Phone ............................................................ Fax ........................................................................................E-mail ..........................................................................................................................................................Can we contact you at this address? yes no

Academic backgroundStarting with the most recent, please list all colleges and universities you attended.Institution, country Degree Dates (attended from... to...) Field of study>Language skillsLanguages Excellent Good FairEnglishMother tongue........................................................................................................................................................................................................................If English is not your mother tongue please indicate how long you have studied and practiced it: Studied...................years Practiced...................yearsTOEFLHave you taken the TOEFL? Yes/date. ...................................................... Total score ................................................................................................No, date you plan to take it ............................................................................................................................................Not applicable because ..................................................................................................................................................2 IHave you taken the GMAT? Yes/date. ...................................................... Total score ................................................................................................No

Work experienceTotal professional experience (in years) ........................................................................................................................................................................................1. Current positionCompany name ......................................................................................................................................................................................................................Sector of activity ....................................................................................................................................................................................................................Size of firm or organisation (turnover in US$ or € and number of employees) ................................................................................................................................Country of operation ................................................................................................................................................................................................................Title/Position ..........................................................................................................................................................................................................................Functional area ......................................................................................................................................................................................................................Your manager’s title ................................................................................................................................................................................................................Number of employees under your supervision ............................................................................................................................................................................Budget you are responsible for..................................................................................................................................................................................................Headquarters’ address ........................................................................................................................................................................................................................................................................................................................................................................................................................................................Phone: ............................................................................................................ Fax: ..............................................................................................................Number of employees ...................................................................................... Turnover in US$ or €: ......................................................................................Human Resources Manager: ....................................................................................................................................................................................................Training Manager: ..................................................................................................................................................................................................................Holding: ................................................................................................................................................................................................................................Nationality: ............................................................................................................................................................................................................................Number of employees ...................................................................................... Turnover in US $ or €: ....................................................................................CEO:......................................................................................................................................................................................................................................Human Resources Manager: ....................................................................................................................................................................................................Training Manager: ..................................................................................................................................................................................................................I 3

Work experience2. From year.................................................................................................... to ................................................................................................................Company name ..................................................................................................................................................................................................................Sector of activity ..............................................................................................................................................................................................................Size of firm or organisation (turnover and number of employees) ............................................................................................................................................Your title/position:..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................3. From year.................................................................................................... to ................................................................................................................Company name ..................................................................................................................................................................................................................Sector of activity ..............................................................................................................................................................................................................Size of firm or organisation (turnover and number of employees) ............................................................................................................................................Your title/position:..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................4. From year.................................................................................................... to ................................................................................................................Company name ..................................................................................................................................................................................................................Sector of activity ..............................................................................................................................................................................................................Size of firm or organisation (turnover and number of employees) ............................................................................................................................................Your title/position:..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................5. From year.................................................................................................... to ................................................................................................................4 ICompany name ..................................................................................................................................................................................................................Sector of activity ..............................................................................................................................................................................................................Size of firm or organisation (turnover and number of employees) ............................................................................................................................................Your title/position:..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

International exposurePlease describe, in order of importance to you, your international exposure (residence abroad, travel, work experience, etc)Dates Activity Country>Activities and interestsPlease list any activities related to your professional life (publications, associations) ..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Please list any activities other than education and employment in which you are/have been involved ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................>EssaysBoth essay topics listed below must be answered. Use separate sheets of paper and staple them together. Everything must be typed and double-spaced. Please indicateyour first and last names at the bottom of each page. Please answer with a minimum of 50 words for each question.1. Choose an achievement from your professional life and describe why you see it as such.2. Please give three reasons why you should be admitted to Executive master Energy and Global Policies.3. Give a candid description of yourself, stressing the personal characteristics you feel to be your strongest and weakest points.I 5

Admission ProceduresApplication ProcedureCandidates applying for Executive master “ Energy andGlobal Policies” must submit the following documentsin English:. A completed application form. A resume. Two letters of recommendation (in sealedenveloppes). Certified copies of diplomas and transcripts. Two photos. The Test of English as a Foreign Language(TOEFL) - for non-native English speakers only. A non-refundable application fee of €120.Incomplete applications will not be reviewed by theAdmission Committee until they have been completed.Application are processed in order of receipt and shouldbe submitted as early as possible. The admissioncommittee will start reviewing application from Juneonwards and until 30 th September.After the application package has been reviewed by theAdmission Committee, the candidate will be notifiedwhether he / she will be invited for an interview atSciences Po.TOEFL scoreIf your native language is not English, you must submitthe results of the TOEFL (minimum score: 250).Non-refundable application feeA non-refundable application fee of € 120 is required tocover processing of the application. Make your bank draftor international money order (no Eurocheque) payable to:«Fondation Nationale des Sciences Politiques»,HSBC France - 41, bd Raspail - 75007 PARIS,Bank Code: 30056Branch Sort Code: 000770Account: 07704589623RIB Key (French banking code): 75Direct debit: HSBC FR Paris Sèvres BAB.The complete application package must be mailed toSciences Po215, boulevard Saint Germain75007 Paris, France.>Applicants must fulfill twoconditions:• a minimum of a 10 yearprofessional experienceat an executive level• a bachelor’s degreeor equivalent.FINANCING YOUR EXECUTIVEMASTER ENERGY AND GLOBALPOLICIESTuition fees for this programme is 25.000 €net of tax.20% for confirmation and 80% beforebeginning of programme.These fees do not include the application fee(€ 120 non-refundable), nor any travel andaccommodation costs during seminars.We remind you that you are personnallyresponsible for the payment of your tuition feesand additional costs.DiplomasA complete application form must include a copy of yourdiplomas.If your diploma is in a language other than English orFrench language, please have it translated and submitthe certified copy.6 I

InvoicingEXECUTIVE MASTER ENERGY AND GLOBAL POLICIES - 09MFI02Tuition bill is to be adressed to ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Contact name ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Additional costs (meals, accomodation and transportation for the seminars) to be invoiced to ....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Contact name ................................................................................................................................................................................................................................................................Date:Employer’s signatureDate:Candidate’s signatureStamp *Statement of integrityAll the information in this application package is true, accurate and complete to the best of my knowledge. I certify that I have formulated and written all narrativeresponses myself. I understand that withholding or giving false information will invalidate my application and make me ineligible for admission to Executive master Energyand Global Policies.DateSignature* We remind you that your employer must be informed and must approve your application. By signing this registration form, you accept all sales conditions given overleaf.I 7

General sales conditions1. REGISTRATIONAll participant registrations will only be confirmed once admission has been granted by the selection panel and once Sciences Po has received:• a registration form, duly completed and signed (together with a letter serving as an order for the bodies concerned);• a payment of 20 % of tuition fees for confirmation and 80 % before beginning of the programme.Without receipt of these documents, Sciences Po reserves the right to freely dispose of places on the course as it sees fit.People with reduced mobility are requested to indicate this fact when registering, so that Sciences Po can ensure access to course venues.2. PRICES• As the Paris IEP (Institute of Political Studies) is exempt from VAT by virtue of article 261-4-4 of the General Tax Code, all prices issued by the Ongoing Education Department constitute the net payablefees in euros.• Prices for Executive Masters degree courses are stated in each of the prospectuses.3. TERMS AND CONDITIONS OF PAYMENTThere is no discount for early payment.Payment of the price of the course may be made through the following means:• by cheque made payable to the “Fondation Nationale des Sciences Politiques”;• by direct transfer, stating the name of the participant, the invoice number and company name, to the account held by the “Fondation Nationale des Sciences Politiques”,HSBC France - 41, bd Raspail – 75007 PARISBank Code: 30056 I Branch Sort Code: 00770 I Account no.: 07704589623 I RIB key: 75 I Direct debit: HSBC FR Paris Sèvres BAB.Any company located outside France but within the European Union must indicate its intracommunity VAT number on the registration form for invoicing purposes.4. ADMINISTRATIONAn invitation letter, indicating the exact venue of the course, will be sent to the participant.One or more invoices, which take the place of a Simplified Training Course Agreement (approval no.: 1175p001275, decision of 28 January 1983), will be sent to the financing establishment.Certificates of attendance will also be sent to the financing establishment.5 - CONDITIONS FOR CANCELLATIONOnce registration has been confirmed and the executive master started, participants will not be allowed to claim completion of the tuition fees already paid.6. FUNDING COMPANY• In the event of a change of employer during a course, all course fees will be invoiced to the original company, unless otherwise agreed in writing by the new employer or unless responsibility is takenby the participant.• Cancellation only takes effect after receipt of a written document (fax, email, letter); an acknowledgement of receipt will be sent by return to the training manager or to the participant in the eventof personal financing.The organisers reserve the right to modify or postpone the course if circumstances outside their control oblige them to do so.In the event of a request for a postponement during the course, approved by the panel, all fees for the current year, increased by 10% are payable.In the event of a postponement of the final oral examination by more than one year, approved by the panel:• a lump sum of €1,000 will become payable;• a lump sum of €2,000 will be payable if the participant requires methodological tutoring;• in the event that the oral examination is not conducted within three years of the end of the course, the participant will not be able to claim completion of the course taken.7. DATA PROTECTIONInformation contained in the registration form, unless otherwise instructed by you, will be processed electronically. In accordance with law no. 78-17 of 6 January 1978 "Computers and the freedomof information", you have the right to access and modify information concerning you.Unless you expressly refuse in writing stating your name, your computerised data may be transferred, rented out or exchanged with other companies.DIRECTION DE LA FORMATION CONTINUE215 boulevard Saint-Germain, 75007 Paris, FranceTel.: +33 (0)1 44 39 07 638 IIFax: +33 (0)1 44 39 07 61dfc@sciences-po.fr I www.sciences-po.fr/spfIFP1 et 4, avenue de Bois Préau - 92852 Rueil-Malmaison Cedex FranceTel.: +33 (0)1 47 52 60 00 I Fax: +33 (0)1 47 52 70 00www.ifp.fr