Please provide to us:

  • This registration form completed
  • A curriculum vitæ
  • A letter of recommendation (see p. 4) and any additional supporting material
  • A recent photograph
  • A copy of your university degree (or equivalent)

All applications should be sent or e-mailed to:

LOUVAIN SCHOOL OF MANAGEMENT - International Executive MBA

Attn: Mrs Nathalie COGNEAU – Program Coordinator

Place des Doyens, 1 – Suite A038

B-1348 Louvain-la-Neuve - Belgium

Email : info @ louvainmba.com - Tel : +32 (0)10 47 83 51

Personal Data

First name:Last name:

Male: Female:

Date (dd/mm/yy): / /Place & country of birth:

Citizenship:

Home address:

Private email:

Private mobile phone:Home phone:

Marital status: Number of children:

Business data

Company name:

Company address:

Company Web site:

Number of employees:

Job title:

Email:

Business phone:Mobile phone:

Invoicing Address:

VAT Nr :

Academic background and professional experience

University degree (descending chronological order)

Degree received / Institution Country / Grade / Start - finish dates

Major field of studies (please tick one box only)

Science
Engineering: 
Sciences: 
Computer Science: 
Medicine & Veterinary: 
Other: 
Economics & Business
Accounting: 
Economics: 
Business & Commerce: 
Management: 
Other Business:  / Law
Law: 
Political Science: 
Public Administration: 
Other Legal: 
Others (please specify)
…………………………………………….: 

Employment (descending chronological order)

Company Name / Job Title / Main duties / Start - finish dates

Current Job title:

Describe your current responsibilities:

Outline your professional career up to now, showing evidence of managerial responsibilities if any:

Describe your major career achievements during last 5 years:

Outline your international experience:

Languages

Indicate your proficiency in each skill (from 1 to 5 where 5 means mother tongue and 1 means basic understanding).

Language / Reading / Writing / Speaking
English
French
Other (please specify)

Motivation

To explain your motivation, please answer questions such as:

  • Why do you want to do a part time Executive MBA?
  • What kind of evolution for your career will you be looking for?
  • Which skills you wish to focus on and why?
  • Why would you choose Louvain’s International Executive MBA program?
  • What are your expectations during and after such IEMBA program?
  • Is the International exposure important for you and why?
  • What do you think you could bring to the group?
  • etc…

Your signature for applying: Date:

Recommendation letter

To be filled out by a member of the company you work(ed) in.

Please provide us with a balanced evaluation of the candidate in a selection of the following areas:

Decision making skills:

Problem solving skills:

Ability to get on with others:

Teambuilding:

Leadership:

Ambition/drive:

Self-motivation:

Proactivity:

Maturity:

Oral communication skills:

Written communication skills:

Quantitative skills:

Tolerance:

Creativity:

Please specify the following items:

Name:

Position:

Company Address:

Tel:

E-mail:

Signature: