CURRENT (OR MOST RECENT) BUSINESS ADDRESS

(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: ( )

Email: .

CURRENT (OR MOST RECENT) BUSINESS ADDRESS more info

Name of company: .

Street, number: .

City: . Postal code: . Country: Switzerland

Telephone: ( ) Fax: ( )

Email: .

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 MBA/The Economist QS MBA Ranking

Poets & Quants Other(s)

MBA Fair: Where? When? MBA Info Session: where? When?: IMD MBA Blog?

(2)

Education, Languages, and International Exposure

1. EDUCATION GMAT score Total

Quant Verbal AWA Integrated

Reasoning

Date Taken/scheduled / /

% % % % % Location

Or

GRE score Quant Verbal AWS Date Taken /

% % % Location

Please list academic programs attended, starting with the Bachelor's (or equivalent), then the Master's (or equivalent/if 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.

Institution/location U/P Field of study Duration

year/months Year Graduated FT/PT Degree Obtained Results Achieved Institution Location / Institution Location / Institution Location / Institution Location / Institution Location / Institution Location / 2. LANGUAGES

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

(month/year) (month/year) Country/Region / - / / - / / - / / - / / - /

(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 (month/year) (month/year)

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:

From/To : - / - Current

* Starting base salary in US$ by year, excluding bonus: * Ending 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

(month/year) * Yearly Salary in US$ starting ending - / - Start End - / - Start End - / - Start End - / - Start End - / - Start End *Please give the exchange rate you used in calculating your yearly salary in US$ :

What is your career goal post IMD?

Maximum 200 characters.

What are the skills you need to develop in order to achieve your goal?

(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 Work Sector

From/To: / -/

(month- Year) (month- Year)

Starting base salary in US$ by year (excluding bonus):

Ending base salary in US$ by year (excluding bonus):

Bonus received over the past 12 months : Budget you control:

Number employees directly under your

supervision : Company website:

Number of employees world-wide: 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.

Reason for taking the position: Reason for leaving the position:

(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?

Maximum 300 words. 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.

(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, GMAT/GRE, a disability or illness, please use this space. (Optional)

Maximum 300 words.

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?

Maximum 300 words.

2. Why are you applying to IMD? What other programs have you considered / are you considering?