EMBA APPLICATION FORM

Transcription

1 Instructions Please be complete and precise in filling in this form. Send it together with the supplementary materials to: Cologne Business School Admissions Office Hardefuststr Cologne Germany All fields need to be filled in. The form should be filled using the English language only. Please provide the following supplementary materials with the completed application form: Application deposit for the amount of 120; check or statement of bank transfer to: Account holder: CBS Cologne Business School Kreissparkasse Köln: Bank code: ; Account number: Reason for payment: EMBA 2012; your name und surname; Certified copies of diplomas, with certified English translation; Certified copies of transcript/grade list. These transcripts have to be embossed with the issuing school s seal, with certified English translation; Two letters of recommendation (letters on official letterhead and signed); Proof of working experience (letter on official letterhead paper by the employer); Valid TOEFL (Test of English as a Foreign Language) score (570 ITP / 88 ibt) or IELTS score (6.5). Required if your first language is not English; Official GMAT scores (500) are recommended, but not required A personal resume in English; Certified statement of financial support. If your studies will be sponsored, you should submit a guarantee of financial support by the sponsor. If you are self supporting you should submit proof of financial support for the amount of the tuition fee and for the living expenses during the program (bank statement). If you do not have a sponsor yet, please indicate where you would like to apply for sponsorship; If you have any questions, please do not hesitate to contact us: Sabine Rüffer EMBA (ESSEC) [email protected] Phone: Fax:

2 1. Program EMBA APPLICATION FORM Executive Master of Business Administration International Business Starting in Personal Mr. Ms. Mrs. Family name First name Middle name Home address (street + no.) City Postal code Country Home telephone (country code, area code, number) - - Home fax (country code, area code, number) - - Mobile phone (country code, number) - - Personal Date of birth (day/month/year) Place of birth Nationality Preferred address for further correspondence: Home address Business address 3. Data needed for visa applications (if applicable) ID Number Passport number Issue place Date of issue (date/month/year) Date of expiration German Embassy/Consulate as place of issue of your visa

3 4. Emergency data Person to be notified Type of relation Address City Postal code Country Telephone (country code, area code, number) - - Fax (country code, area code, number) - - Mobile phone (country code, number) Educational background Highest qualification PhD degree Master degree Bachelor degree College degree Other List any academic distinctions, honors or scholarships received History (list most important programs attended up to three with most recent first) 1. Educational institute/university Degree/diploma Yes, degree Yes, diploma Major

4 2. Educational institute/university Degree/diploma Yes, degree Yes, diploma Major 3. Educational institute/university Degree/diploma Yes, degree Yes, diploma Major 6. Professional background Current employer Name organization/company Type of organization Government NGO Semi-government Private company Business address City Postal code Country Business telephone (country code, area code, number) - - Business fax (country code, area code, number) - - Mobile phone (country code, number) - - Business Current position in position since Description of duties and responsibilities

5 Previous employers 1. Name organization/company Position held Description of duties and responsibilities 2. Name organization/company Position held Description of duties and responsibilities Professional Society memberships: 7. Letters of Recommendation Two letters of recommendation on official letterhead from individuals who can evaluate your professional experience and judge your likelihood of success in this program (e.g. your current/previous managers) should accompany this application. Names and positions of the two people sending the letters of recommendation: 1. 2.

6 8. Areas of Management Indicate your relative degree of knowledge in each of the areas listed below: Basic Good Excellent Accounting Business Law Business Ethics Economics Finance International Business Management Information Systems Marketing Mathematics Operations Organizational behavior Research Skills Statistics Strategy GMAT taken Yes If yes, date taken Score 9. Proficiency in English Indicate your relative degree of knowledge in each of the areas listed below: Basic Good Excellent Oral Written English Language test taken: TOEFL IELTS If yes, date taken Score Other English language test taken Result

7 10. Professional Objectives for your study What are your professional/learning objectives? List your most important expectations regarding this study? What other information would you like to add, that would aid the Admission Committee? 11. Other Who recommended you this program? Please indicate how you heard about the program Relative Internet Publications/advertisement in: Fair Other:

8 Housing Do you wish to stay in the Maastricht School of Management (MSM) guesthouse? (during the sessions in Maastricht) (Attention: Final confirmation of reservation has to be done by the student) Yes Do you need support in finding housing during the sessions in Cologne? Yes 12. Statement I certify that the information given in this application form is complete and accurate to the best of my knowledge. I permit the Cologne Business School (CBS) and Maastricht School of Management (MSM) or its agents to use all means reasonable to verify the information I have provided in this application. I am aware of the amount of the tuition fees and I certify that I have the means to pay for those fees and that in addition I have or command the funds to pay for my lodging and living expenses during my stay in Germany and the Netherlands as well as for the travel, hotel and living expenses for the module in China. I am aware and agree to the fact that only under exceptional circumstances tuition fees can be (partially) refunded and that such refunds will only take place after it has been established that I have returned to my home country and my Student residence Permit Card has been handed in at the German or Dutch Diplomatic representation in my home country or to the CBS s or MSM s appointed representative. In case of admission, I hereby appoint the Cologne Business School or the Maastricht School of Management to arrange my health insurance that I know to be compulsory by German and Dutch law for international students and will arrange for payment of the policy before my arrival in Germany or in the Netherlands. I am aware that I have to pay a deposit in advance in case I appoint CBS or MSM to arrange for my housing and I am admitted to the program. My application to the program implies that in case of admission I accept to abide with the students regulations of the Cologne Business School or Maastricht School of Management. Signature of applicant Place & Date

9 Sponsorship statement Name: Country: My application is financially supported by Myself My employer My government A fellowship Other Name of sponsor Address City Postal code Country Telephone (country code, area code, number) - - Fax (country code, area code, number) - - Period of support, from until Total amount of sponsorship: Sponsorship includes expenses for Tuition fee & study materials International travel Laptop computer Board and Lodging Medical insurance Allowance during the program ( per month) Others: Signature of sponsor Place & Date Official stamp