FACT IMPACT PLANET 2019-2020: Application Form
The objective of this questionnaire is to get to know your organization, assess your needs and identify the main areas on which the FACT IMPACT PLANET program can be suitable for you.

The FACT IMPACT PLANET is a seven-month program lead by HEC Paris Business School. Using a specific methodology, students from HEC will carry out a social impact evaluation for your organization.

This program is divided in three stages :
1. 4-months of training in Paris and preparation of the field-mission, from February to May.
2. 6-weeks of field mission in your organization, from June to July.
3. A post-mission evaluation.

For more information about this program and the services we offer, please contact us at info@connexioworld.com
Email address *
CONTACT INFORMATION
Please let us know who you are and how we can contact you!
Your full name *
Your answer
Organization's name *
Your answer
Your position within the organization *
Your answer
Organization's website *
Your answer
City and country of the organization *
Your answer
Your email *
Your answer
Telephone *
Your answer
Skype ID *
Your answer
YOUR ORGANIZATION
How do you define your social/environmental mission? *
What are your organization's objectives ?
Your answer
Activities *
Please tell us more about what your organization does : the sector in which it operates, its main activities.
Your answer
Who are the beneficiaries and/or targeted clients of your product or service? *
Your answer
Year of creation *
Your answer
What is your organization's development stage? *
Number of employees *
Your answer
Who are your organization's most important partners? *
Your answer
YOUR NEED FOR SUPPORT
What are the main challenges your organization is facing today? *
Your answer
Why is a social impact assessment important for your organization? *
Which objectives would you like to reach with the FACT IMPACT PLANET mission?
Your answer
Imagine a team of 3-4 students that could provide strategic guidance regarding the social/environmental impact of your organization: what tasks would you give them? *
Your answer
DETAILS ABOUT THE FACT IMPACT MISSION
Location *
Where would the mission take place (country / regions / cities)?
Your answer
Timeframe *
The FACT IMPACT PLANET field-mission takes place from June to July during 6 weeks. The students will arrive at your organization at this time. Is this timeframe suitable for you? Also, will you be available to remotely assist the students (for exemple, Skype calls at least twice a month) during the 4-month training and preparation of the field-mission?
Required
Internal referee *
Within your team, who would be responsible for the supervision and follow-up of the FACT IMPACT PLANET mission? Please provide his/her name, position within the organization, email and contact information.
Your answer
Languages *
Which languages do students need to know ? Can you involve any translator, if needed ?
Your answer
MISSION COST AND BUDGET
Can your organization cover the local expenses? *
Accomodation, local transportation and food for a team of 3 or 4 students? What type of accomodation can you provide?
Your answer
WOULD YOU LIKE TO RECOMMEND US SOMEONE ELSE?
Do you know any other impactful organization that would like to participate in this program?
If so, please give us their contact information.
Your answer
Where did you hear about us? *
Your answer
Anything else you would like to tell us? Do you have any further questions?
Your answer
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