CURRENT (OR MOST RECENT) BUSINESS ADDRESS

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1 Personal Data Application for the IMD MBA Program starting in January Family Name(s):. First Name:. Middle Initial: Preferred name or nickname: Sex: M F Age at start of program: Date of birth: Place of birth: Marital Status: Citizenship: Other Citizenship(s): FAMILY INFORMATION Relation First Name Last Name Birth Date Citizenship Company-sponsored: Yes No Not decided If yes Fully Partially Amount in CHF: Do you intend to apply for an IMD MBA loan? Yes No Amount in CHF: Does your employer know that you are applying to IMD? Yes No Have you filed an application for any previous IMD MBA Programs? Yes No If so, for which year? Have you visited the IMD campus? Yes No If so, when: HOME ADDRESS more info Street, number: City: Postal code: Country: Switzerland Telephone: ( ) Mobile: ( ) . CURRENT (OR MOST RECENT) BUSINESS ADDRESS more info Name of company:. Street, number:. City:. Postal code:. Country: Switzerland Telephone: ( ) Fax: ( ) . Please state if it is appropriate for you to be contacted at this address: Yes No WHAT WERE YOUR SOURCES OF INFORMATION ABOUT IMD? Online, press and MBA guide article(s)? Beat the GMAT Bloomberg Business Week BusinessBecause ChaseDream Financial Times Forbes GMAC mba.com GMATClub Handelszeitung MBA Career Guide Official MBA Guide Pagalguy Poets & Quants Princeton Review QS Career Guide QS Top MBA Telegraph The Economist The mba Admissions Handbook The Times Wall Street Journal Other(s) MBA Ranking : Which one(s)? Bloomberg Business Week Financial Times Forbes Wall Street Journal Which MBAThe Economist QS MBA Ranking Poets & Quants Other(s) MBA Fair: Where? When? MBA Info Session: where? When?: IMD MBA Blog? Other blogs: IMD Alumni or Participants: Other source(s).. Page 1 6

2 Education, Languages, and International Exposure 1. EDUCATION GMAT score Quant Verbal AWA Integrated Date Takenscheduled Total Reasoning % % % % % Or GRE score Quant Verbal AWS Date Taken % % % Please list academic programs attended, starting with the Bachelor's (or equivalent), then the Master's (or equivalentif any), then the PhD or other postgraduate (if any); other significant programs, or courses that do not fit the above, can be entered in the last few lines. Also indicate if the institutions are universities (U) professional schools (P) and whether you attended as a full time (FT) or part time (PT) student. 2. LANGUAGES location UP Field of study Duration yearmonths Year Graduated FTPT Degree Obtained Achieved Results Number of Languages Spoken Mother tongue Rate your proficiency in other languages : Fluent, Good (working knowledge), Fair (simple conversation), Poor (some understanding) Language Reading Writing Speaking Where and how did you learn this language English 3. IMPORTANT AND INTERNATIONAL EXPOSURE Please list below the most important times of your life when you have lived, studied, worked or traveled (minimum 1 month) outside your own country Category Activity From - To CountryRegion (monthyear) (monthyear) Page 2 6

3 Activities, Brief Employment Summary, Career Goal Value coming from page 1 4. FULL-TIME OR PART-TIME EXTRA CURRICULAR ACTIVITIES. SPORTS, VOLUNTEER ACTIVITIES, POLITICS, HOBBIES, MILITARY, TRAVEL AND PERSONAL PROJECTS. From - To (monthyear) (monthyear) Organization Activity Position held 5. BRIEF EMPLOYMENT SUMMARY & CAREER GOAL Number of years of full-time work experience at the start of the program: Current or most recent company:. Country: Switzerland Job title: FromTo : - - Current * Starting base salary in US$ by year, excluding bonus: * ing base salary in US$ by year, excluding bonus: Previous positions held : Please start with most recent and list only post-graduation, full-time positions. Company Country Job title From - To (monthyear) *Please give the exchange rate you used in calculating your yearly salary in US$ : What is your career goal post IMD? - - Start - - Start - - Start - - Start - - Start * Yearly Salary in US$ starting ending Maximum 200 characters. What are the skills you need to develop in order to achieve your goal? Maximum 200 characters... Page 3 6

4 Employment Details Value coming from page 3 For each full-time position held, please complete a separate section. Do not include part-time jobs, internships, or summer jobs. Begin with your current (or most recent) position. 1. Employer:. 6.1 EMPLOYMENT DETAILS Employer. Company Affiliate of Country Switzerland Annual turnover in US$: Nature of business: Job title: Function *Click here for more Info FromTo: Starting base salary in US$ by year (excluding bonus): Bonus received over the past 12 months : Number employees directly under your supervision : Number of employees world-wide: - (month- Year) (month- Year) Work Sector ing base salary in US$ by year (excluding bonus): Budget you control: Company website: Number of employees locally Responsibilities: Firstly please give us a two-line description of the nature of your business. Then summarize briefly and concisely the nature and scope of your job, your overall responsibilities, and where appropriate, the number of staff you supervise, and the US dollar value of physical and financial resources for which you are accountable. Please make it clear to the Admissions Committee what you feel you have contributed to your company and give examples of achievements, as well as relevant international exposure. Maximum 150 characters. Maximum 950 characters. Reason for taking the position: Reason for leaving the position:.. Page 4 6

5 Essays Essay 1: Describe yourself in two hundred words or less Maximum 200 words. Essay 2: Give an example of a time when you were confronted with an unrecoverable event. How did it affect you and what were your greatest learnings? Essay 3: On your 75th birthday someone close to you presents your laudatio (tribute). It can be a friend, colleague, family member etc. Please describe in detail what this person would say about you and your life... Page 5 6

6 Additional Questions Is there any additional information that is critical for the Admissions Committee to know which has not been covered elsewhere in this application? If you would like to comment on career gaps, education, GMATGRE, a disability or illness, please use this space. (Optional) Administrative Questions Your responses to these questions will not be taken into consideration in the admissions process. 1. How do you intend to finance your MBA at IMD? What would your budget be? 2. Why are you applying to IMD? What other programs have you considered are you considering?.. Page 6 6