Application Form | Imperial College Business School

Page 1

Please select the programme you are applying for

Programme Date

Personal Information

Family name

Title

Date of Birth DD/MM/YYYY

First name (s)

Name by which you prefer to be known

Gender

MaleFemale

Nationality

Private Address

Country

Telephone

Mobile

Fax

Professional Information

Job Title

Company

Parent Company

Your business address

Postcode / Zip Code

Country

Telephone

Mobile

Fax

Work Email

Company website address

Job title of the person to whom you report

How many people report to you?

Directly

Indirectly

Years of relevant work experience

Years of relevant management experience

Page 2

Personal Statement

1. What are your objectives for attending this programme and what do you expect to gain from the programme?

2. What are your 3 main work responsibilities?

3. How did you hear about this programme?

What function best describes your current position?

Please specify

Please select your industry sector*

Please specify

Please choose the most appropriate job level

Page 3

Sponsoring Executive Information

Please tick which statement applies to how your attendance on the programme will be sponsored.

My organisation is sponsoring meI am self-sponsored and my organisation is not sponsoring me

Name of Sponsoring Executive

Email of Sponsoring Executive

Page 4

HR Contact Information

Job Title

Family name

First name (s)

Address

Postcode / Zip Code

Country

Email

Telephone

Receiving relevant information

Please tick here if this contact would like to receive information relevant to their role from Imperial College Business School in the future

Admissions and payment

Application forms will be acknowledged within 48 hours and reviewed and accepted once the completed Sponsoring Executive form has been received.

Payment is due upon acceptance. Imperial College Business School programmes are highly competitive, and places will not be guaranteed until payment is received. Accommodation is not included in the programme fee.

Cancellations

All cancellations must be confirmed in writing to j.coyne@imperial.ac.uk and will only be effective from the date of receipt.
Cancellations received more than 42 days prior to the commencement of the programme will be subject to a £500 administrations fee.

Cancellations received after that time will be subject to the following penalties:

0 - 14 days 100% of the programme fee.
15 - 28 days 50% of the programme fee
29 - 42 days 25% of the programme fee

If a candidate does not attend, the full fee will be retained as a cancellation charge

Please note that no part of the fee will be refunded or used towards payment for another programme in the event a participant only partially attends the programme.

In the unlikely event that we cancel a programme, participants will be entitled to a full refund.

Other Important Information

Applicants must be proficient in English. All classes and discussions are conducted in English. To obtain maximum benefit from participation, participants are expected to attend all activities which form part of the programme.
No academic credits are granted for participation in Executive Education programmes.
Imperial College reserves the right to remove any participants acting in any way detrimental to the programme or the other participants.
We reserve the right to take photos of or video participants while they participate in programme activities, and use such photos or video footage for promotional purposes.