Page 1 of 7
/International Center for
Promotion of Enterprises
Ljubljana, Slovenia /
Combined Application for Admission and Enrollment
In
Professional Programme in Public Management andEnterprise Development, IIPA
And
Masters Programme in Economics and Business Sciences, FEB
(Executive MBA Programme, 2012-2013)
Please send the completed application form to:
Programme Coordinator
PPPMED, (Executive MBA)
Indian Institute of Public Administration
Indraprastha Estate, Ring Road
New Delhi-110002
Phone: 011-23731791 and 23468352
Email:
PPPMED (EMBA) Application Form
Page 1 of 7
Application Checklist
Application form duly completed (incomplete applications will not be considered).
Photocopies of all degree certificates (certified translations if degree is not in English)
Corporate Sponsorship Letter or Letter of Support. (the format is provided in the Programme Brochure).
Refundable Ernest Money Deposit of Rs 30,000/-[*] (Thirty Thousand only) by
demand draft favouring ‘DIRECTOR, I.I.P.A., New Delhi, India’.
THREE recent passport size color photographs (excluding One affixed on this form).
Clear attested photocopy of first and last two inner pages of applicant’s valid passport.
Important Instructions to Applicants
1. Duly Completed Applications are to be accompanied by all documents and EMD.
2. Applications must be sent by Registered Post/ Speed Post/ Courier.
3. Last date for receiving applications is 6th August 2011.
1. Personal InformationMr. / Ms. / Last Name ______/ First Name ______/ Maiden Name ______/ (if applicable)
Sex Male / Female / Date of birth ______/ Place of birth ______/ Country ______/ Nationality ______
Valid Passport No . in full .______Issued on ______/ Expires on ______
2. Permanent Address
Street ______/ P.O. Box ______/ Town/City ______/ Post code ______/ Country______
Home phone ______/ Mobile phone ______/ Fax ______/ E-mail (must be valid until program start) ______
3. Business Address
Street ______/ P.O. Box ______/ Town/City ______/ Post code ______/ Country ______
Home phone ______/ Mobile phone ______/ Fax ______/ E-mail (must be valid until program start) ______
N.B. Please keep us informed, should your contact information change during the application process.
How would you prefer us to communicate with you?
By post By e-mailBy telephoneBy fax
4. Academic Background
Please indicate below the three most important and recent degrees you have completed in reverse chronological order.
Level of highest degree obtained:
PhD/ Doctorate / Master’s / UndergraduateDuration From / To / Name of University or College / Field / Degree received / Full/Part time
5. Please indicate the area in which you obtained your bachelor's degree (Please mark one box only)
Science (e.g., Biology, Chemistry, Informatics, Computer)
Health & Medicine (e.g., Medicine, Pharmaceuticals, Dentistry, Veterinary)
Engineering (e.g., Electrical, Industrial, Architectural, Building, Mechanical)
Social Science (e.g., Economics, Law, Social Science, Political Science)
Business & Management (e.g., Management, Management Information Systems, Business Administration)
Arts & Humanities (e.g., History, Languages, Arts)
Others (e.g., Agriculture, Education, Media, etc) Please specify ______
In which language(s) was your university degree taught? ______
6. Professional Background
Please list each full-salaried position after your first degree obtained in reverse chronological order, starting with your most recent position and accounting for any gaps.
a) Current Position
Duration From / To / Company / City, country of Work / PositionBriefly summarize your current job responsibilities
Number of employees in subsidiary ______Name and number of employees worldwide of parent company ______
Number of direct and total subordinates ______Responsible for budget of GHC or US$ ______
Company Sector ______/ Job Function ______Do you belong to a project team? / Yes / No
If yes, please describe briefly your team’s duties, sizes etc. (max. 50 words).
______
______
______
Please draw a simplified organizational chart of your company. Mark your position in the chart with an “X.
Please indicate the name of the Human Resources Manager in your company.
Mr. / Ms. / Last Name ______/ First Name ______Business phone ______/ Mobile phone ______/ Fax ______/ E-mail ______
Please indicate the name of the person in charge of Management Development/Training in your company.
Mr. / Ms. / Last Name ______/ First Name ______
Business phone ______/ Mobile phone ______/ Fax ______/ E-mail ______
b) Previous work experience
Duration From / To / Company / City, country of Work / PositionTotal duration in years of full-time positions held (by the beginning of the EMBA program) ______
Of which years ______in a leadership position and ______in international assignment
7. International Experience
Please list your most significant international experiences growing up, studying or working outside your own country.
Duration From / To / City, Country / Activity8. English Language Proficiency
To be admitted to the PPPMED EMBA program, you must be fluent in English.
Please indicate in the table below the level at which you situate your proficiency in English. Use the following for self-assessment.
Level 1 The ability to participate in a conversation about daily life
Level 2 The ability to understand, speak and write with structural accuracy, communicate and read newspapers, as well as to give adequate information about future career goals
Level 3 The ability to conduct business in English
Level 4 The ability to interact in any circumstances with the near-ease of a native speaker Level 5 Native language
9. Awards, Honors, etc.
Please list any honors, distinctions, awards you have received in your academic, professional or extracurricular activities.
From / To / Awards, Honors, etc. / Institution / Explanation10. Why did you choose PPPMED Executive MBA?
Please indicate the reasons for applying for this program. In your opinion, what differentiates us from other programs?
______
______
______
11. Inscription Data
Inscription Data / DetailsHigher-education institute / University of Maribor, Faculty of Economics and Business
Study programme / Economic and Business Sciences
Programme-direction / Management, Organisation and Human Resources
Year of study / 1st year
Study course 5 / Master’s Programme
Study type 6 / Part-time
Before submitting your application, please use the checklist on the first page of the application form to ensure that your application is complete and on time. We encourage you to talk to your employer before applying for the program.
Statement of Accuracy:
I hereby certify that the information contained in this application is complete and correct to the best of my knowledge.
Date______Applicant’s full signature______Place ______
PPPMED (EMBA) Application Form
[*] Ernest Money Deposit will be refunded in full if candidate is not selected. It will be adjusted against programme fee if Candidate is selected. In the event of selected Candidate not confirming his candidature the EMD will be forfeited.