International Executive Masters OpT

Application form – Year2017-18

APPLICATION FORM

Year2017-2018

International Executive Master OpT

For urban watersupply and sanitation service managers

Advanced Master accredited by the FrenchConférence des GrandesEcoles

Water for All Chair – International Executive Master OpT

AgroParisTech – 648 rue JF Breton – BP 44494 – 34093 Montpellier cedex 5 – France

Tel.: +33 (0)4 67 04 71 41/9 - Fax: +33 (0)4 67 04 71 01 -

International Executive Masters OpT

Application form – Year2017-18

APPLICANT

Title / Mr / Ms
SURNAME
Forename / Middle name
Date of birth
Place of birth / Country of birth
Nationality
Address
Post code
City / Country
Landline / Mobile
E-mail address
Marital status / Married / Single
Number of children

COMPANY

NAME
Address
Post code
City / Country
Representative / SURNAME / Forename
Title
Landline / Mobile
E-mail address

Water for All Chair – International Executive Master OpT

AgroParisTech – 648 rue JF Breton – BP 44494 – 34093 Montpellier cedex 5 – France

Tel.: +33 (0)4 67 04 71 41/9 - Fax: +33 (0)4 67 04 71 01 -

International Executive Masters OpT

Application form – Year2017-18

PROFESSIONAL EXPERIENCES

Current position
When did you start in this position?
Department
City
Direct supervisor / SURNAME / Forename
Title
Phone number
E-mail address
Describe your responsibilities and tasks
Previous positions
Period / Employer / City/Country / Title, position

EDUCATION AND KNOWLEDGE

A-Levels or equivalent
Date / School
Specialty / City / Country
Highestdiploma
Date / Level
Name / Specialty
Institution / City / Country
Other trainings and qualifications
Date / Institution / Name and specialty
IT tools / Beginner / Intermediate / Advanced
Word processor (MS Word or other)
Spreadsheet program (MS Excel or other)
Multimedia program (MS Powerpoint or other)
Languages / Begginer / Intermediate / Advanced / Fluent
English
French
Other:
Knowledge of France
Have you been to France before (dates, duration of stay, object)

MOTIVATIONthe Selection committee will pay particular attention to this part

What are your motivations for applying to the Executive Masters OpT programme?
What are your career plans? (short and mid-term plans)

Individualworkassignment

Throughout the course, each trainee will work on an individual work assignment, which corresponds to a development project for a drinking water and/or sanitation service in a city, in his country. This work assignmentis the core element of the training programme. It leads each trainee to methodically and logically apply the knowledge gained during the training to a real situation in their country. Thiswork assignment leads the trainee, with the support of the education team, to adopt an approach of analysis and preparation of the action, mobilising information sources, teams and partners in the company.
The development of the project is broken up into three phases (Diagnostic → Strategic plan → Action plan). The trainee will come back to his/her company twice during the training (2 x 6 months)
Assignmentsubject:
Service in which the assignment will be conducted:
City
Type of service
Perimeter of served area
Total population in the served area / Actual population served
Head manager of the service
Is the company in charge of operations and maintenance the applicant’s employer?
yes / no
If no, name of the operator :
Further useful information about the assignment (300 words max.): objectives, work assignment details…

The individual work assignment is defined by the trainee and his/her direction.

FINANCIAL DETAILS

All expenses (tuition fees and living expenses) are estimated at 30 000€
- tuitionfees / €18000
- living expenses* (in France and at the training partners’) / €12000
*Living expenses include: a monthly allowance of about €600, the accommodation on the training site, social protection.
Travelling expenses (plane tickets) between the country of origin and the training site are not included.
This amount does not take into account the trainee’s salary, which is maintained throughout the training course.
Provisional financing of training expenses
Company (applicant’s employer)
Third organisation / (developmentbank, financial organisation, etc.)
NAME
Personcontacted
E-mail address
Results / accepted / pending / refused

The English speaking 2015-16course is expected to start in January 2015. This will be confirmed as soon as possible.

Date:

Applicant’s signature / Company representative’s signature
(name, titleand stamp)

Please return the completed application file with a CV and a photograph to AgroParisTech / Water for All Chair, by e-mail, fax or mail:

-E-mail:

-Fax: +33(0)4 67 04 71 01

-Mail: Chaire Eau pour Tous

AgroParisTech

648 rue Jean-François Breton – BP 44494

34093 Montpellier cedex 5 - FRANCE

Water for All Chair – International Executive Master OpT

AgroParisTech – 648 rue JF Breton – BP 44494 – 34093 Montpellier cedex 5 – France

Tel.: +33 (0)4 67 04 71 41/9 - Fax: +33 (0)4 67 04 71 01 -