MBA in Healthcare Management February 2016

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1 Application Form: Intake: MBA in Healthcare Management February 2016 Instructions You have chosen to apply for the Amsterdam MBA Healthcare Management programme of the Amsterdam Business School. In order to be eligible for admission you must meet the admissions requirements. In order to apply you need to submit the completed application form together with the following required documents (scans of the original documents suffice for the application process. After your admission we need to receive the original documents or certified copies of these documents): - Copy of your passport or ID; - Curriculum vitae; - University transcripts (grade list; in English or in Dutch); - University diplomas (in English or in Dutch); - Motivation letter (stating why you want to pursue an MBA degree in Healthcare Management, why the Amsterdam Business School, what your career perspectives are, your strenghts, your improvement points during the programnme, and your added value to the class. Your letter should not exceed 700 words); - Two recommendations (your referees should fill out the Amsterdam MBA recommendation form and them back directly to this is mandatory.) Admissions process Please find below the process that follows after you submitted the application: - After receiving your complete application we will evaluate your profile. - In case of a positive outcome we will invite you for the admissions interview. - After the interview your application will be discussed by the Admissions Committee. Within maximum 4 weeks you will receive a final decision. - If you are admitted we will ask you to sign a participation agreement and pay a non-refundable enrolment fee of 2,000 in order to secure your place in the Amsterdam MBA Healthcare Management programme. The enrolment fee is part of the total tuition fee and will be deducted from the tuition fee later (not applicable if you are a candidate from the alliance AMC-VUmc). - In the first weeks of the programme we need to see and or receive your original documents or certified copies of these documents (i.e. diplomas, transcripts, etc.)

2 PLEASE NOTE: all fields with red outline are mandatory 1. Programme information Programme: MBA in Healthcare Management Part-time programme (24 months) 2. Personal details First name (given) Middle name (if any) First name of preference Gender Date of birth (dd/mm/yyyy) Place of birth Country of birth Nationality Second nationality 3. Current residence information Please fill in a permanent address. will be the primary means of communication throughout the process. Make sure to provide us with the correct contact details to ensure smooth communication. Street Address Street Address Line 2 City State (if applicable) Zip Code Country Phone number (with a country code) Skype ID 4. Educational background 4a. The highest completed degree Applicants are required to hold a recognized Bachelor or Master degree from research university in a relevant field.

3 Institute City Country Obtained degree Title of study Attended dates: From (dd/mm/yyyy) To (dd/mm/yyyy) Date of graduation (dd/mm/yyyy) Language of instruction 4b Other higher education degree (optional) Institute City Country Obtained degree Title of study Attended dates: From (dd/mm/yyyy) To (dd/mm/yyyy) Date of graduation (dd/mm/yyyy) Language of instruction 5. Language requirement English language proficiency This requirement is not applicable for the Special Track in Healthcare Management. Dutch language proficiency Understanding of the Dutch language is required. Please note that all courses, except for one, are taught in Dutch. 6. Work experience A minimum of five years of relevant healthcare experience is required.. Please answer the following questions about your current or latest position. Please first indicate how many years and months of work experience you have (e.g. 5 and a half year: Years: 5; Months: 6). Then answer the following questions about your current or latest position. Total number of years and month(s) of your full-time employment as it will be at the start of the programme (end of January 2016)

4 Number of years months Current or latest employer (name of the company) Country of employment Job title Number of employees under your supervision Link to your LinkedIn profile 7. Financial plan The Amsterdam MBA Healthcare Management tuition fee is 35,000. (a different financial plan is applicable to Alliance AMC-Vumc candidates) You can pay your tuition fee in equal instalments spread over the duration of the programme (in total 6 instalments) Please indicate below how you will finance your study (select all applicable options): Own savings Bank loan My employer will (partially/fully) finance my studies Other (please specify) Please note: you can lower your tuition fee for this MBA programme if you are paying taxes in the Netherlands; you can deduct the tuition fee from the income tax. 8. Additional information If you have any additional questions and/or remarks regarding your application, please fill them out below.

5 Emergency Contact First name Primary phone number Relationship (family, friend, etc.); any additional vital information 9. Application check-list for additional documents Please select below all additional documents you will be ing to address in order to complete the full application file Copy of passport / ID Curriculum vitae Motivation letter Transcripts (grade list) University diploma(s) Please indicate below names and addresses 2 referees to whom you have ed the MBA Reference Form One reference letter will come from: First name Second reference letter will come from: First name

6 10. Signature I hereby confirm all the information in this application form and in attached required additional documents (listed in paragraph 10) is true, accurate and complete to the best of my knowledge. I understand that giving false information or withholding any relevant facts will invalidate my application and make invalid my admission to the Amsterdam MBA Healthcare Management programme at Amsterdam Business School. Date (dd/mm/yyyy) Place Signature Please print the completed form, sign and back together with additional required documents (listed in paragraph 10) to the Amsterdam MBA Healthcare Management admissions office at

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