邢唷>? ?欹'` ,bjbjVwVw 1D44睳9HHHXhhhT???|(H,8|`?釬釬釬釬I .IBI [z]z]z]z]z]z]z榽hr]zh驥霩霩"驥驥]zhh釬釬 騵沋沋沋驥h釬h釬[z沋驥[z沋沋V_b@hh#c釬? 扮僻d?酭焍 wd|08|玝xr稴r#c#crh7c@NI麵|沋xJd躂NININI]z]z=Y^NININI8|驥驥驥驥d 膸 hhhhhh Application FormDossier de candidatureof (de)  FORMTEXT      Master in Managementof theConservatoire National des Arts et Metiers Cnam  Ecole MS  Dept MIP  Case 1D3P40  Programme MIM 2 rue Cont, 75141 Paris Cedex 03, France telephone: +33 1 58 80 87 49 fax: +33 1 58 80 87 50 (Attention to燏 Mrs Tra NGUYEN) ChecklistListe des pi鑓es fournirApplication for admission to the CNAM朚IM Master in Management requires the following documentsLe dossier de candidature au programme Master du CNAM朚IM exige les documents suivantsOne copy of this application form accompanied by two (2) photographs, 1 photo by electronic versionUn exemplaire de votre dossier d抜nscription accompagn de 2 photos d抜dentit et 1 photo num閞ique  FORMCHECKBOX One copy of your passport (page with personal information and photo)Copie de la page d抜nformation de votre passeport  FORMCHECKBOX An official copy of your post-secondary degree certificate(s) Copie conforme du baccalaur閍t ou dipl鬽e 閝uivalent  FORMCHECKBOX An official transcript of all post-secondary education Copie conforme des dipl鬽es obtenus lors du cursus universitaire  FORMCHECKBOX Evidence of English language proficiency Preuve de capacit en anglais comme langue 閠rang鑢e FORMCHECKBOX Note2 letters of reference which conform to CNAM朚IM guidelines 2 lettres de r閒閞ence conformes au mod鑜e CNAM朚IM FORMCHECKBOX NoteIf your application is being supported by your current employers, the Employer Sponsorship formEn cas de prise en charge par votre employeur actuel, le formulaire Participation de l抏mployeur  FORMCHECKBOX  A non-refundable application fee of Euros 125 either by cheque or by bank transfer with the bank details Frais de dossier non rembours閟 Euros 125 par ch鑡ue ou virement bancaire  FORMCHECKBOX One electronic version (scanned type) of all above application forms & documents and one electronic photograph, in the format of JPG (less than 300KB each documents)  FORMCHECKBOX CNAM BANK DETAILSBeneficiary抯 NameTitulaire du compteRAR Ecole Management et SocieteBeneficiary抯 Address(Postal address)Site Saint Martin, 292 rue Saint Martin, 75141 Paris Cedex 03, FranceBeneficiary抯 A/CRIBFR 76 1007 1750 0000 0010 0418 247Beneficiary抯 Bank name TP PARIS or Banque de FranceBeneficiary抯 Bank addressRecette G閚閞ale des Finances de Paris 94, rue Reaumur, 75104, Paris cedex 02S.W.I.F.T. BICTRPUFRP1Beneficiary抯 NameTitulaire du compteRAR Ecole Management et SocieteBeneficiary抯 Address(Postal address)Site Saint Martin, 292 rue Saint Martin, 75141 Paris Cedex 03, FrancePlease be attention that all the fees of bank transfer (sender抯 & receiver抯 fees) are at students charge. (Choosing M1 + one of options in M2 or choosing only one option of M2 if you are qualified to enter directly to M2) FORMCHECKBOX M1 Master 1 Core curriculum FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX M21 - Major in Project Management & Business EngineeringMR079p2M22 - Major in Sustainable Development & Global Quality ManagementMR080p2M23 - Major in International Business & Corporate DevelopmentMR072p2M24 - Major in Organization Consulting & Change Management(MR087p1  in French)Surname/Family name  FORMTEXT      NomAttach a photograph of yourselfAfficher une photo d identitFirst name  FORMTEXT      PrnomGenderSexe  FORMCHECKBOX  Male " Masculin FORMCHECKBOX  Female " FmininNationality  FORMTEXT      Nationalit Civil status  FORMTEXT      Situation de famille# children  FORMTEXT   Nb enfantsPersonal address Addresse personnelle  FORMTEXT      Postal code  FORMTEXT      Code postalCity  FORMTEXT      VilleTelephone  FORMTEXT      TlephoneCountry  FORMTEXT      PaysEmail  FORMTEXT      Fax  FORMTEXT      Date of birth (dd-mm-yyyy)  FORMTEXT      Date de naissance (jj-mm-aaaa)Place of birth (as written in the passport)  FORMTEXT      Lieu de naissanceContact in emergencyContact en cas d urgence  FORMTEXT      Telephone  FORMTEXT      TlphoneCountry  FORMTEXT      Pays Educationtudes Undergraduate education (higher education leading to the Bachelor s degree)tudes suprieures University Etablissementfromdeto Major SpecialitDegree Diplme Graduation date Obtenu le FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Graduate education (higher education leading to the Master s or Doctoral degree)tudes suprieures University Etablissementfrom detoMajor SpecialitDegree Diplme Graduation date Obtenu le FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      IELTS, GMAT, TOEFL or equivalentDateLocation " Lieu Score " Rsultat  FORMTEXT       FORMTEXT       FORMTEXT      English language certifications Comptences en anglais comme langue trangreCertification " Diplme DateScore " Rsultat FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       LanguagesLanguesLanguage LangueVerbal fluency Expression oraleWritten fluencyExpression ecrite FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermdiaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediaire  FORMCHECKBOX BasicBases FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermdiaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediaire FORMCHECKBOX BasicBases FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermdiaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediare  FORMCHECKBOX BasicBases FORMTEXT       FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Interm閐iaire  FORMCHECKBOX BasicBases FORMCHECKBOX Fluent Courrant  FORMCHECKBOX Intermediate Intermediaire  FORMCHECKBOX BasicBasesPrizes, scholarships, distinctionsPrix, bourses, distinctions FORMTEXT      Military serviceService militaire FORMTEXT      Professional or other certificationsAutres formations professionnelles ou diplmantes FORMTEXT       FORMCHECKBOX  Other & Autre &  Work experienceExpriences professionnellesCurrent employer  FORMTEXT      Employeur actuelSince  FORMTEXT      DepuisJob title  FORMTEXT      PosteEmployment addressAdresse professionnelle  FORMTEXT      Telephone  FORMTEXT      TlphonePosition description  FORMTEXT      Descriptif de poste Major responsibilities  FORMTEXT      Previous employment Emploi prcedentEmployer " EmployeurLocation " LieuPosition " Postefrom " deto "  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      EssayDissertationRespond to the four (4) questions that follow in 300 words or less.What are your career goals over the next 5 years, and what role will this Master play in achieving them? FORMTEXT      Describe and analyze one (1) key business, or personal, or life achievement. FORMTEXT      Describe and analyze one (1) key business, or personal, or life failure you have experienced. FORMTEXT       Describe and analyze one (1) important leadership event you have experienced. FORMTEXT       How did you learn about the CNAM-MIM Master in Management?Comment avez-vous connu le Master du CNAM-MIM? FORMCHECKBOX  Printed material  FORMCHECKBOX  email FORMCHECKBOX  CNAM-MIM web site FORMCHECKBOX  Internet search FORMCHECKBOX  Word of mouth FORMCHECKBOX  employer FORMCHECKBOX  friendOther:Autre: FORMTEXT      DeclarationDclarationAll information given in this application is accurate and truthful to the best of my knowledge.Je certifie que toutes les informations fournies dans ce document sont exactes et sincres.Details of my educational qualifications and work experience may be checked by CNAM朓IM with the organisations and authorities concerned.Le CNAM朓IM pourra demander aupr鑣 des organisations et autorit閟 concern閑s tout detail utile concernant les 閠udes sup閞ieures ou les r閒閞ences professionnelles du candidat(e).I hereby apply for admission to the Master in Management program of the CNAM朓IM. If admitted to the program, I agree to obey all statutes and regulations of CNAM-MIM.Je demande par la pr閟ente mon admission dans le programme Master du CNAM IIM et, si je suis admis, je m engage respecter toute l organisation et tous les rglements du CNAM IIM.Signature FORMTEXT      Date FORMTEXT      Place " Lieu FORMTEXT       Reference formFormulaire de recommandationName of candidate  FORMTEXT      Nom du candidat(e)The individual named above has applied for admission to the CNAM IIM Master in Management program. We will appreciate your completing this reference form and returning it to CNAM  IIM/ MIM, Cas 1D3P40, 2 rue Cont? 75003 Paris, France or sending it as attachment to  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.fr Le candidat(e) susnomm a demand son admission dans le programme Master du CNAM朓IM. Nous appr閏ierions que vous acceptiez de compl閠er ce document d抋ppr閏iation et que vous le retourniez au CNAM MIM, 2 rue Cont? 75003 Paris, France ou l抏nvoyiez  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.frIn what capacity have you known the candidate, and for how long?Dans quelles conditions avez- vous connu le/la candidat(e) et depuis quand? FORMTEXT      What are this person s strongest characteristics?Quelles sont les principales qualits du candidat(e)? FORMTEXT      What are this person s three characteristics in greatest need of development?Quels sont les domaines dans lesquels le/la candidat(e) devra s amliorer?  FORMTEXT      What circumstances might affect the candidate s ability to complete the CNAM-MIM Master?Y-a-t il des facteurs susceptibles de compromettre l aptitude du candidat(e) intgrer le Master du CNAM IIM? FORMTEXT      Please rate this candidate on the characteristics indicated belowSuperior Excllent Top 5%Very goodTrs bonTop 15%GoodBonTop 30%FairMoyenMid rangePoorM閐iocreLower %No opinion Sans avisIntegrityInt間rit FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual abilityCapacit intellectuelle  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual breadthChamps de connaissances  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Mathematical abilityCapacit math閙atique  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Written communicationCommunication 閏rite  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Oral communicationCommunication orale  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX CreativityCr閍tivit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-management  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Motivation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX MaturityMaturit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to adapt to a foreign cultureCapacit s抋dapter une culture 閠rang鑢e  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Perseverance  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-confidenceConfiance en soi  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to work with others"NPRT`bvxz熘贸爫uaFu%uAjh$h$5?*CJOJPJQJU^JaJmHnHo(u5jh h5?*CJOJQJU^JaJ&h$h$5?*CJOJQJ^JaJ/jh$h$5?*CJOJQJU^JaJ%h$B*CJ0\乚乤J0mH ph€€€sH %h$h$5丆J0\乚乤J0mH sH h$5丆J0\乚乤J0mH sH %h?PB*CJ0\乚乤J0mH ph€€€sH +h$h?PB*CJ0\乚乤J0mH ph€€€sH %h$h?P5丆J0\乚乤J0mH sH  "P( $ゐ$Ifa$gd莢b$むむ$Ifa$gd莢b8kdj$$IfT擸 . €6a.麏T$$Ifa$gd莢b $$Ifa$gd莢b$a$gd?Pgd?P*& ( * ^ n z 栀呛晢uf\R\RH@7/h僆h?P\h?P\乵H sH h?PmH sH h?PCJmH sH h舗CJmH sH h僆CJmH sH h?P5丆J"\乤J"mH sH  h?P5丂CJH\乤JHmH sH h?P5丆JH\乤JHmH sH h?PCJ\乤JmH sH h?P5丆J"\乤J"h?P5丂CJ(\乤J(h?P5丂 CJ\乤J"h$h?P5丆J\乤JmH sH h$h?PCJaJmH sH .h$h$5丅*CJ0\乚乤J0mH ph€€€sH ( * S T U _ z { umd[ $Ifgd!?J $Ifgd莢b$a$gd?P6kd.$$IfT. 6a.麏T $$Ifa$gd莢b$ゐ$Ifa$gd莢b8kd$$IfT擛 . €6a.麏T    2 R S T U y z |   2 3 4 e h j k x z 黠栳柃搪谭瑲晲晢znzbVRNRNRJh!?Jh> 1h?Ph?PCJaJmH sH h?PCJHaJHmH sH h僆B*mH ph€€€sH h?PB*mH ph€€€sH h?P5丅*ph€€€ h僆5 h?P5?h?Ph?P5丆J\乤JmH sH h!?Jh?PmH sH h?Ph?PmH sH h僆h?P5乗h僆h?P5丆J\乤J h僆h僆 h僆h東 h僆h?Ph僆h?P\h僆h舗\{ | 3 4 G2 & F€??$Ifgd莢bEkd$$If杔??€]& t6櫃44 layt $$Ifa$gd莢b$??$Ifa$gd莢bUkd$$If杔敔??f#?? t644 laz      V _ 爨煸烊俯灃拠wsdUJ?hhmH sH hh> 1mH sH hhB*mH ph€€€sH hh> 1B*mH ph€€€sH h> 1h?PCJaJh莢bCJaJjIh+WQUh莢bjh莢bUh鑠?h莢bmH sH h鑠?h?PCJaJmH sH h?PB*CJaJmH ph€€€sH h?B*mH ph€€€sH h僆B*mH ph€€€sH h?PB*mH ph€€€sH h鑠?B*mH ph€€€sH h?Ph?   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We will appreciate your completing this reference form and returning it to CNAM  IIM/ MIM, Cas 1D3P40, 2 rue Cont, 75003 Paris, France or sending it as attachment to  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.fr Le candidat(e) susnomm a demand son admission dans le programme Master du CNAM IIM. Nous apprcierions que vous acceptiez de complter ce document d apprciation et que vous le retourniez au CNAM  MIM, 2 rue Cont, 75003 Paris, France ou l envoyiez  HYPERLINK "mailto:tra.nguyen@cnam.fr" tra.nguyen@cnam.fr In what capacity have you known the candidate, and for how long?Dans quelles conditions avez- vous connu le/la candidat(e) et depuis quand? FORMTEXT      What are this person s strongest characteristics?Quelles sont les principales qualits du candidat(e)? FORMTEXT      What are this person s three characteristics in greatest need of development?Quels sont les domaines dans lesquels le/la candidat(e) devra s amliorer?  FORMTEXT      What circumstances might affect the candidate s ability to complete the CNAM-MIM Master?Y-a-t il des facteurs susceptibles de compromettre l aptitude du candidat(e) intgrer le Master du CNAM IIM? FORMTEXT      Please rate this candidate on the characteristics indicated belowSuperior Excllent Top 5%Very goodTrs bonTop 15%GoodBonTop 30%FairMoyenMid rangePoorMdiocreLower %No opinion Sans avisIntegrityIntgrit FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual abilityCapacit intellectuelle  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Intellectual breadthChamps de connaissances  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Mathematical abilityCapacit mathmatique  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Written communicationCommunication crite  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Oral communicationCommunication orale  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX CreativityCrativit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-management  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Motivation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX MaturityMaturit  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to adapt to a foreign cultureCapacit s adapter une culture trangre  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Perseverance  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Self-confidenceConfiance en soi  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ability to work with othersCapacit travailler en quipe  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Name of referee  FORMTEXT      Nom du rfrent Degrees held / institution(s)  FORMTEXT      Diplmes obtenus / institution(s) Position and addressPoste et adresse  FORMTEXT      Telephone  FORMTEXT      Fax  FORMTEXT      Email  FORMTEXT      Signature FORMTEXT      Date  FORMTEXT      Employer sponsorship formParticipation de l employeurName of candidate  FORMTEXT      Nom du candidat(e)Organisation  FORMTEXT      EmployeurAddress  FORMTEXT      Name of direct supervisorNom du responsable hirarchique FORMTEXT      Name of individual completing this formNom de la personne ayant rempli le formulaite FORMTEXT      Telephone FORMTEXT      Fax FORMTEXT      Email FORMTEXT      Telephone FORMTEXT      Fax FORMTEXT      Email FORMTEXT      Please highlight the candidate s current responsibilities.Indiquez, svp, les responsabilits actuelles du candidat(e). FORMTEXT      Please briefly assess the candidate s career potential.Votre avis sur les potentialits de carrire du candidat(e). FORMTEXT      Please outline this organization s plan for the candidate s career development.Quel est le plan de dveloppement de carrire prvu pour le candidat(e) dans l entreprise? FORMTEXT      To support the candidate s development, please indicate areas / issues on which this program should focus.Afin de rpondre aux besoins du candidat(e) dans l objectif de son dveloppement, prire de nous indiquer les points importants appuyer durant le programme. FORMTEXT      Will this organization support the candidate in some way (financially or otherwise)?L employeur soutiendra-t-il le candidat(e) et de quelle manire (financirement ou autre)? FORMCHECKBOX YesOui FORMCHECKBOX NoNonIf yes, in what way and to what extent?Si oui, comment et dans quelle mesure? FORMTEXT      Signature FORMTEXT      Date FORMTEXT       A high level of English fluency is required. If English is not your mother tongue, you will be asked to submit results from the TOEFL, the Test of English as a Foreign Language, or another internationally recognized certification of English language competence that is accepted by the CNAM IIM. (IELTS, GMAT, etc.) Check with an official representative for details. Letters of reference should make use of the CNAM IIM form supplied for this purpose, and may be accompanied by a personal letter from your referee. 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