APPLICATION FOR ADMISSION Executive MBA in Business Renewal PERSONAL DETAILS Family name /Surname First name(s) Date of birth Place of birth Nationality Native language(s) Present country of residence Home address Postal code City Country Telephone E-mail Preferred mailing address Home Work 1
JOB DESCRIPTION Current employer (company or organization) Current job title Department (if applicable) Date of appointment to present position Number of people you supervise Please describe your main /current responsibilities: EDUCATIONAL BACKGROUND Please give below the details of your highest OR the most relevant degree you have taken. Degree Major subject University or institution Country Year of graduation 2
ENGLISH LANGUAGE PROFICIENCY Please tick the appropriate: Native Fluent Good Basic YOUR AMBITIONS AND MOTIVATION Please state your objectives in attending this program. What can you contribute to this EMBA program? How much time do you have for your EMBA studies considering your schedules at work as well as commitments in your personal life? 3
EMBA THESIS Please give a preliminary topic for your EMBA thesis: REFERENCES Please provide a list of references from persons who know you professionally. Please specify the name, job title or position and company/organization of the person in question. ENDORSEMENT BY THE EMPLOYER My employer is willing to support my EMBA studies by: Paying for the whole program Paying for the part of the program Time commitment If your employer is paying for the whole program or a part of it, a representative of the company should sign below: Name and signature of authorising superior including job title and position in the company /organization. Date and place Signature Name Job title /position Company /organization 4
How did you find out about the EMBA in Business Renewal program? Contact from TUT From my company /organization (my superior, HR, colleague etc.) Executive MBA Tampere website Personal contact; please specify who: Advertisement; please specify which publication, website etc. Other; please specify: TERMS OF PAYMENT The tuition fee for the Program 2015-2017 is 31 200 + VAT 24%. The fee is payable in four (4) installments as follows: 1 st installment 2 nd installment 3 rd installment 4 th installment 6 000,00 + VAT 24% in October 2015 9 000,00 + VAT 24% in April 2016 9 000,00 + VAT 24% in October 2016 7 200,00 + VAT 24% in April 2017 Kindly note! The fee does not include costs for the elective studies (20 ECTS). Participants are responsible for their own travel, meal and accommodation costs in the Orientation and Immersion Module in Finland and the international Module to Switzerland. CANCELLATION TERMS Registration for the EMBA program is a binding agreement. After the acceptance to the EMBA program a training program agreement is drawn up with the participant and participant s employer (if applicable). In case participation is cancelled when the program has already started, the current year s installments will be charged in full. The possible remaining installments will be charged with a rate of 50 %. 5
STATEMENT OF INTEGRITY I hereby certify that I have provided accurate information in this application form and that I am the only author of the information in this application form. I authorize Executive MBA in Business Renewal program responsible organization to verify the information. I understand that any information that is not correct in my application may lead to cancellation of admission or withdrawal from the Executive MBA in Business Renewal program. Date and place Signature Name ENCLOSURE Curriculum Vitae in English RETURN ADDRESS FOR SIGNED APPLICATION AND CV Edutech / TUT Saila Leivo PO Box 1001 (Korkeakoulunkatu 7) FIN-33721 TAMPERE Kindly note! The deadline for submitting the application form and required enclosure is September 21, 2015. You will receive an acknowledgement that your application and the enclosures have been received by Edutech. FURTHER INFORMATION Contact person: Saila Leivo, Program Manager at Edutech Tel. +358 40 569 8835 saila.leivo@tut.fi 6