To support your application for a research-based master’s or doctoral program, please provide the following information and send this form to one or more Polytechnique Montréal professors working in your field of interest. Remember to attach your résumé.

Contact and program

Student’s name:

Name of professor contacted:

Other(s) professor(s) contacted or that you plan to contact:

Desired study program: Research-based master’s	Doctorate	Other
MOTIVATION FOR UNDERTAKING A RESEARCH-BASED MASTER’S OR DOCTORAL PROGRAM

Please describe your motivations and research interest for undertaking a master’s or doctoral program with the preferred professor.

When do you expect to begin your studies?	End of August Year:	January Year:	May Year:
RESEARCH INTERESTS

Subjects of interest/of specialization (5 to 8 keywords): 1. 2. 3. 4. 5. 6. 7. 8.
PRIOR STUDIES (start with the most recent)

Name of establishment:	Country:
Diploma:	Date of graduation (expected or actual): Year / Month
Average in your last year of study:	Ranking in your cohort (if available):
Cumulative average for all years of study for this degree:
Name of establishment:	Country:
Degree obtained:	Date of graduation (expected or actual): Year / Month
Cumulative average for all years of study for this degree:	Ranking in your cohort (if available):
PUBLICATIONS

Scientific publications in peer-reviewed journals, articles presented at conferences: Yes No

If yes, please attach the article(s), in PDF format, when submitting this form.
Name of the journal or conference:	Title of your article/paper:
Name of the journal or conference:	Title of your article/paper:
*If you have published more than two articles, please mention this in your résumé.

INDUSTRY OR LABORATORY INTERNSHIPS

Performance of industry or laboratory internships: Yes No
Location of internship:	Purpose of internship:
Location of internship:	Purpose of internship:

SCHOLARSHIPS FOR ACADEMIC EXCELLENCE

Have you been awarded a bursary? Yes No
Amount:	Start date:

End date:
Name of the organization that provided the bursary:
Amount:	Start date:

End date:
Name of the organization that provided the bursary:
Do you intend to apply for a bursary as part of your research project? Yes No
Name of the organization:	Amount:
Name of the organization:	Amount:
* If you have been awarded more than two bursaries for academic excellence, please note this in your résumé.

LANGUAGE SKILLS

French

Spoken: Yes No

If yes, Beginner Intermediate Advanced

Written: Yes No

If yes, Beginner Intermediate Advanced

TFI grade (optional):	English

Spoken: Yes No

If yes, Beginner Intermediate Advanced

Written: Yes No

If yes: Beginner Intermediate Advanced

TOEFL grade (optional):	Other language(s):
*If necessary, Polytechnique may require you to take language classes.

ADDITIONAL COMMENTS / OTHER POINTS IN SUPPORT OF YOUR APPLICATION

Please add any other information you deem relevant (specific realisation, awards, honors, main courses, etc.)

DEADLINES FOR RECEIVING GRADUATE STUDIES APPLICATIONS

Fall semester	Winter semester	Summer semester
Canadian and permanent resident students	May 1	October 1	February 1
International students (visa)	March 1	June 1	November 15
*The application form is available to the following address: http://www.polymtl.ca/admission/en/

KEY CONTACT INFORMATION

RECRUITMENT SERVICES

http://www.polymtl.ca/sr/ (in French only)

Contact: monavenir@polymtl.ca

OFFICE OF THE REGISTRAR

http://www.polymtl.ca/registrariat/en/

Contact: registraire@polymtl.ca

Polytechnique Montréal
Local A-201
C.P.6079, succ. Centre-ville
Montréal (Québec), H3C 3A7	FINANCIAL ASSISTANCE

http://www.polymtl.ca/futur/es/en/financement/montant.php

http://www.polymtl.ca/aidefinanciere/ (in French only)

Contact: afe@polymtl.ca

Please send the information above directly to the professor concerned.

STUDENT–PROFESSOR CONTACT REGARDING SUPERVISION

OF A RESEARCH-BASED MASTER’S DEGREE OR DOCTORATE

The information provided herein does not replace the Polytechnique Montréal

application form

Maude Bourassa

2015-01-23

École Polytechnique de Montréal