EMBA APPLICATION FORM

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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. 1 50677 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: 370 502 99; Account number: 133 270 778 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) E-mail: [email protected] Phone: +49-221-93 18 09 -650 Fax: +49-221-93 18 09 - 50

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1. Program

Executive Master of Business Administration International Business Starting in 2013 2014 2015

2. 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 e-mail ______________________________________________________

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 ____________________

___________________________________________________________________

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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) ____ - ______ - _______________________

E-mail _____________________________________________________________

5. 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 _______________________________________

Start date _________________________________ finish date ________________

Degree/diploma Yes, degree Yes, diploma No

Major ______________________________________________________________

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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 E-mail ______________________________________________________

Current position _______________________________________ in position since Description of duties and responsibilities __________________________________

___________________________________________________________________

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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. ________________________________________________________________

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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 No

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 _____________________________________________________________

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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: ________________________________

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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 No

Do you need support in finding housing during the sessions in Cologne?

Yes No

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

_________________________ ___________________________

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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) ____ - ____ - _______________________

E-mail _____________________________________________________________

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